Health Belief Model (HBM) (Nursing)

00:00 Today, we're going to talk about the Health Belief Model.

00:05 As public health nurses, it's important to remember that in order to have a positive influence on health behaviors, we first need to understand the reasons why our patients choose their behaviors.

00:16 What influences their decision to get vaccinated or not get vaccinated? What influences their decisions to smoke cigarettes or stop smoking? In this presentation, I'll explain the Health Belief Model.

00:28 This is the model that can be used to help nurses better understand health behaviors and develop interventions that have the most impact on our patient's health.

00:38 So, this is the Health Belief Model.

00:40 As you can see, it includes several parts, parts that we call constructs.

00:45 Now, before I explain each of the constructs, I want to give you a little bit of background about the model.

00:51 This model was developed in the early 1950s by social scientist at the US Public Health Service.

00:57 It was developed in order to help us understand the failure of people to engage in disease prevention strategies.

01:04 Now I know this model looks complicated, so let me break it down in the most simple terms.

01:10 Overall, the model assumes that can bind a person's health belief in the threat of an illness and their belief about the effectiveness of a treatment can predict the likelihood of adapting a desired behavior.

01:24 So let's go back to the image of the model and break down each construct individually.

01:29 Let's first start with modifying variables.

01:33 These are characteristics that are specific to the individual.

01:37 They include age, sex, race, ethnicity, education.

01:42 In addition to demographics, here we also consider knowledge and psychosocial variables such as social class, paranorms, and peer pressure.

01:51 This model suggests that together these modifying variables affect all other constructs of the model.

01:58 Because of these, modifying variables indirectly impact health behaviors.

02:03 Now, beyond these variables, the model includes 6 constructs. So let's locate each of those.

02:09 So let's go to our yellow boxes, perceived seriousness and perceived susceptibility.

02:14 Perceived seriousness is a person's feelings about the seriousness of acquiring a specific illness or disease.

02:21 This could also be their feelings about the seriousness of leaving a disease untreated.

02:26 Here, a person considers the consequences of disease such as death or decreased quality of life.

02:32 They also consider the social consequences such as impact on family and friends.

02:37 The model assumes that those who feel like the severity of an illness is high will be more likely to engage in a health-promoting behavior than those with a low evaluation of severity or seriousness.

02:50 Perceived susceptibility.

02:52 This is a person's perception about the risk of acquiring an illness or disease.

02:57 This is how vulnerable when things they may need to acquiring a disease.

03:01 The Health Belief Model assumes that those who believe they're at higher risk are more likely to engage in health-promoting behaviors than those who do not leave themselves to be at risk.

03:11 Together, perceived seriousness and perceived susceptibility make up another construct called perceived threat.

03:19 Perceived threat is seen here in the middle in blue.

03:23 The Health Belief Model assumes that an individual's overall perceived threat of acquiring an illness is a result of how serious they think the illness is and how likely they think they are to be impacted by the illness.

03:36 So let's stay in the middle here and bump up to perceived benefits versus perceived barriers.

03:41 Perceived benefits. This is a person's perception of how effective a preventative action or a disease treatment will be.

03:49 So, does the individual think that the treatment will be effective? Do they think it will actually make them feel better? If the perceived benefit is low, a person is less likely to engage in the health-promoting behavior.

04:01 Now let's talk about perceived barriers.

04:03 This is a person's feelings about the barriers to engaging in a recommended health behavior.

04:08 Barriers could include cost or accessibility.

04:12 So, can the patient afford the treatment? Is the recommended treatment available under community or are there transportation barriers? If the barriers are perceived to be greater than the benefit, the likely of engaging in the behavior is low.

04:26 So let's stay in this blue column and jump down to self-efficacy.

04:30 This refers to a person's level of confidence in his or her ability to successfully perform a health-promoting behavior.

04:37 So, does an individual believe that they can do what's being asked of them? Do they think they can cut down on fatty foods? Do they think they can take their medications appropriately? If self-efficacy is low, they are less likely to engage in that specific behavior.

04:51 And then finally, we have cues to action.

04:55 Cues to action are the trigger needed to begin a recommended health action.

04:59 These cues can be internal such as chest pain or the inability to engage in a special activity because of health reasons.

05:07 They can also be external. It could be getting advice from a friend or a healthcare provider.

05:12 Maybe the illness of a family member or even reading something on social media.

05:17 Either way, these cues to action encourage people to begin a health-promoting behavior.

05:22 And the more cues they see, the more likely the person will be to engage in that behavior.

05:27 Together, modifying variables in the 6 constructs of the model allow us to better understand the likelihood of engaging in health-promoting behaviors.

05:36 And that's what you see on the far right side of this model.

05:40 Now you might ask yourself why is this so important? Well, the more we understand about why a person does not engage in a healthy behavior, the better we can be at developing interventions that are actually effective in changing behaviors.

05:53 So let me walk you through a quick case study and I'll ask you a few questions along the way that will help you categorize factors that influence decisions.

06:00 From there, we can brainstorm ideas for effective interventions.

06:06 Imagine you're taking care of a patient named Susan.

06:09 She has recently been diagnosed for sleep apnea and has been prescribed the use of a CPAP to use every single night to treat her condition.

06:16 However, at her 1-month appointment, Susan explains to you that she has not been using her CPAP.

06:22 So when you start to ask her questions about why, these are some of the reasons she provides.

06:27 Susan says she doesn't think that sleep apnea will cause her any troubles.

06:32 She states that it's not a big deal, doesn't require any treatment.

06:35 She says that she feels just fine physically even though she has the diagnosis.

06:41 So take a second, think about the entire model.

06:45 Now, what construct that her response best align with? Her response aligns with perceived seriousness. She doesn't think it's a big deal.

06:57 She doesn't think sleep apnea is serious.

07:00 So based on this, how might you work with her to encourage her to use her CPAP? This is where we use the information that we gained to develop an effective intervention.

07:10 Here, we might provide education on the short-term and long-term risk associated with sleep apnea.

07:18 Now, she also tells you that her CPAP is uncomfortable.

07:21 It's uncomfortable to wear every night, and she's also worried about what her partner thinks.

07:25 She thinks that her partner will think she looks silly.

07:28 What construct does this best align with? This best aligns with perceived barrier.

07:39 She is telling you all of the reasons that she can't wear her CPAP.

07:44 So based on this information, what might your approach be here? To address the comfort issues, maybe you do a fit check to make sure that she's wearing the best size for her face.

07:55 You may also encourage her to talk to her partner about her concerns.

07:58 It's likely that this is no concern to her partner at all.

08:03 So, based on this example, we see the importance of understanding why or why not a patient engages in behavior.

08:09 Imagine Susan mentioned her discomfort and you started educating her about the long-term risk of sleep apnea.

08:15 Now, while you might mean well, your approach is not addressing the real reasons that she won't wear a CPAP.

08:22 The Health Behavior Model provides structures so we can better understand why our patients engage or do not engage in a health behavior.

08:29 It also allows us to design interventions that are specific to their unique needs.