What Is the Health Belief Model? An Updated Look

Early detection through regular screening is key to preventing and treating many diseases.

Despite this fact, participation in screening tends to be low. In Australia, only 40% of adults opted for screening for bowel cancer in 2021 — 3% lower than the previous year (Australian Institute of Health and Welfare, 2023).

Why do people decide not to participate in a low-risk activity like screening? Or visit the dentist regularly, or quit smoking? Why do we choose to ignore these necessary health steps?

Why and how people view the risks of disease, and the subsequent likelihood of people adjusting their behaviors, can be better understood with the health belief model.

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A Brief History of the Health Belief Model

Researchers knew that socioeconomic, sociocultural, and demographic factors, such as age, gender, ethnicity, and race, influenced the likelihood that people could afford health care and would seek it out (Abraham & Sheeran, 2015). However, what researchers observed in the 1950s surprised them.

In the 1950s, screening for tuberculosis was made easier and more accessible with mobile X-ray vans, removing the need for patients to make costly and time-consuming trips to hospitals and clinics. What social psychologists Hochbaum, Rosenstock, and Kegels observed was surprising: Despite the increased accessibility and convenience, there was meager participation (Daniati et al., 2021; Skinner et al., 2015). Why would this be?

These researchers posited that patients’ beliefs, attitudes, and understanding of the illness and health care greatly influenced the likelihood that they would seek preventive treatments and screening (Janz & Becker, 1984). This hypothesis resulted in the health belief model (HBM).

The HBM consisted of the following five concepts:

1. Perceived susceptibility describes the individual’s belief about the likelihood of getting a particular health condition.
2. Perceived severity refers to the individual’s belief about the seriousness of the health condition and its consequences.
3. Perceived benefits describe the belief in the effectiveness of taking action to reduce risk or seriousness of the health condition.
4. Perceived barriers refer to the perceived obstacles or costs associated with taking action to reduce the risk or seriousness of a health condition.
5. Cues to action are triggers that prompt individuals to take action, such as symptoms, media campaigns, or recommendations from health care providers.

The health belief model was later modified to include additional factors. These are self-efficacy, our belief in our ability to take action, and the importance of socio-demographic factors.

Here is a short video that uses a simple example to explain the HBM.

Although the original use case of the HBM was to explain low participation in preventive screening programs for diseases, it has since been applied to other scenarios. These include smoking cessation treatments, vaccination programs, and treatment adherence.

Primary Components of the Health Belief Model Theory

The health belief model consists of several vital components for understanding and predicting health-related behaviors.

These components explain how individuals gauge the threat of behaviors and illnesses and interpret and value the efficacy of treatment, ultimately shaping their decision to adopt health-promoting behaviors (Abraham & Sheeran, 2015).

We will go through each component in more detail below.

1. Perceived susceptibility

Perceived susceptibility refers to how an individual’s belief in their vulnerability to a specific disease can lead to preventive actions and behaviors. For example, people who believe they are at severe risk of contracting the flu are more likely to opt for a flu vaccine.

2. Perceived severity

People are more likely to engage in behaviors to mitigate health issues when they perceive a health issue as serious and think that it might impact their lives. This is known as perceived severity. For example, knowing the risks of smoking-related diseases can encourage quitting.

3. Perceived benefits

Perceived benefits describe how individuals are also more likely to engage in certain behaviors if they positively perceive the benefits of those behaviors. For example, people who perceive the benefits of regular exercise positively are more likely to exercise than people who undervalue or do not recognize the benefits of exercise.

4. Perceived barriers

Perceived barriers refer to the severity and difficulty of obstacles/barriers that can significantly impact whether individuals are likely to adopt certain behaviors. If people have to overcome many obstacles to achieve a particular goal, they are less likely to adopt and maintain the behavior.

These obstacles can be practical, psychological, or social and can include cost, inconvenience, fear, or a lack of social support. More examples of barriers include the cost of a gym membership, clinic location, the psychological effort to complete a task, or the time needed to exercise.

5. Cues to action

The fifth component, cues to action, prompts individuals to take action regarding their health. These cues can be internal, such as personal experiences, or external, such as advice from health care providers.

These cues influence health-related decision-making and actions by closing the gap between awareness of health risks and the initiation of appropriate health behaviors. For example, people know when to seek out a health care professional if they can identify symptoms of certain illnesses.

6. Self-efficacy

Self-efficacy is the sixth component added to later adaptations of the health belief model. Self-efficacy is our belief in our ability to perform healthy behaviors successfully. Higher levels of self-efficacy are associated with greater motivation and persistence in adopting and maintaining health-promoting behaviors.

Examples of self-efficacy are trusting in our ability to succeed and recognizing that we have the skill set and knowledge to overcome challenges.

3+ Health Belief Model Application Examples

The health belief model can be applied to several health-related contexts to explain behavior and participation (Abraham & Sheeran, 2015).

Some examples include:

• Programs that tackle preventive behaviors, such as screening, risk behaviors, vaccinations, and contraceptive behaviors
• Adherence programs for the treatment of various illnesses
• Clinic visits

We will briefly look at a few of these applications in more detail.

Smoking cessation programs

To measure knowledge and perception of health behaviors related to smoking cessation, health educators and practitioners used questionnaires measuring various components of the HBM (Renuka & Pushpanjali, 2014). The aim of the study was to determine whether attitudes, behaviors, and knowledge of tobacco use could change through health care education.

This study was specifically conducted in dental care settings due to the relationship between tobacco use and dental health. Tobacco use is correlated with various dental illnesses and conditions, including dental cancer and cleft lip and palate (Renuka & Pushpanjali, 2014).

Results of the study showed that health behavior and knowledge around tobacco and smoking behaviors improved overall. Dental behavior also significantly improved, but only for younger participants, participants who smoked tobacco products (as opposed to vaping), and individuals who already visited the dentist at least once per year. So improvement in these three domains reduces the risk of oral diseases associated with smoking.

Cancer screening campaigns

Research has shown that incorporating HBM components into cancer screening campaigns is compelling and informative. For example, Luquis and Kensinger (2019) found that two components of the health belief model — perceived susceptibility and perceived seriousness — significantly predicted whether younger adults were likely to regularly screen for various cancers.

Vaccination campaigns

Previous studies have found a significant correlation between several components of the HBM and vaccination hesitancy. A systematic review of 16 studies with over 30,000 participants found that vaccine hesitancy was linked to perceived barriers in a positive way (Limbu et al., 2022).

On the other hand, vaccine hesitancy was linked to perceived benefits, perceived susceptibility, cues to action, perceived severity, and self-efficacy in a negative way (Limbu et al., 2022). These results confirm previous findings in the literature (e.g., Mercadante & Law, 2021).

With this insight, health authorities and organizations can use the HBM to encourage vaccination uptake by addressing:

• Individuals’ perceptions of susceptibility to vaccine-preventable diseases
• The severity of those diseases
• The benefits of vaccination for personal and community health
• Strategies to overcome vaccine-related barriers, such as vaccine hesitancy and misinformation

Other areas where the health belief model has been successfully applied include:

• Diabetes (Gillibrand & Stevenson, 2006; Sharifirad et al., 2006)
• Exercise (King et al., 2013)

Interestingly, applying the HBM outside the medical domain has had less success. For example, research suggests that the HBM has limited predictive value in explaining and improving seat belt usage (Şimşekoğlu & Lajunen, 2008; Tavafian et al., 2011).

These examples illustrate how the health belief model can inform the development and implementation of health promotion initiatives across various health issues.

Updates and Modifications to the HBM

Over the years, the health belief model has undergone several updates and modifications to address its shortcomings and criticisms.

Some of these updates and modifications include the following.

Inclusion of additional constructs

One significant modification involves the inclusion of additional constructs beyond the original components of the HBM. For example, self-efficacy, which refers to an individual’s belief in their ability to perform a specific behavior successfully, was incorporated into the model following research by King (1982, as cited in Abraham & Sheeran, 2015).

King argued that self-efficacy was an excellent predictor of patients attending hypertension screening (King, 1982, as cited in Abraham & Sheeran, 2015). Over time, this concept merged with research into locus of control and perceived control and became known as self-efficacy.

Integration with social cognitive theory

The efficacy of the health belief model is improved when used alongside other theories. One such example is the social cognitive theory (SCT).

Social cognitive theory emphasizes the role of observational learning, social influence, and self-regulation in shaping health behaviors (Abraham & Sheeran, 2015).

Integrating SCT with the HBM provides a more comprehensive understanding of how individuals’ beliefs, social environment, and self-efficacy influence health-related decisions and actions.

Incorporation of technology

With the advancement of technology, researchers and practitioners have explored the use of digital platforms, mobile apps, and online interventions to apply the principles of the health belief model in promoting health behaviors.

These technology-based interventions leverage interactive features, personalized feedback, and social support to enhance individuals’ motivation, self-efficacy, and engagement in health-promoting activities (Kim & Park, 2012).

Additionally, when paired with the technology acceptance model to measure the perceived usefulness of the internet for health information and attitudes toward internet use for health purposes, the positive effects of the HBM are amplified and the model is strengthened (Ahadzadeh et al., 2015).

Overall, the updates and modifications to the health belief model reflect efforts to enhance its theoretical robustness, practical utility, and cultural relevance in promoting health behavior change across diverse populations and settings.

Criticisms of the HBM

Initial criticism of the model focused on the poorly defined constructs underpinning the HBM and its poor predictive statistical power (Armitage & Conner, 2000).

Although changes have been made, not all researchers and authors agree about the improvements and modifications made to the health belief model.

Some of the controversies associated with the improvements and modifications include theoretical disagreements about the underlying constructs that compose the model. Also, there is substantial overlap between models explaining health behavior, such as the health belief model and another theory, protection motivation theory (Abraham & Sheeran, 2015).

Other criticisms include the fact that the HBM largely ignores structural barriers. For example, changing attitudes and beliefs about health care does little to combat the cost of health care treatment (Wong et al., 2020).

Despite these controversies and challenges, the health belief model remains a valuable framework for understanding and promoting health behavior change.

Researchers continue to explore its applications, refine its constructs, and evaluate its effectiveness in diverse contexts. The debates surrounding the HBM contribute to ongoing discussions within health psychology and public health, fostering critical reflection and innovation in theory and practice.

6 Worksheets and Interventions

Implementing the health belief model in a coaching or counseling setting can be valuable for helping individuals understand their health beliefs, perceptions, and behaviors.

Health belief model scale

Various HBM scales exist, and the difference between them is their application, because the scales measure beliefs and attitudes around a disease, behavior, treatment, or intervention of interest.

For practitioners interested in using questions from a health belief model scale to measure clients’ attitudes toward a particular treatment or behavior, they will need to adapt existing tools and interventions to incorporate the model’s principles.

• To measure attitudes toward exercise, readers can refer to Wu et al. (2020). They developed an 18-item scale with good psychometric properties. For questions around other behaviors, such as lifestyle or prevention, readers can refer to Şimşekoğlu and Lajunen (2008).
• To measure HBM constructs around self-examination, see Abraham and Sheeran (2015).
• For readers who are interested in focusing on only one component of the HBM and want to know how to adapt or target those aspects, see Orji et al. (2012). They have a useful table detailing various interventions that can be applied for each submeasure.

Health belief assessment worksheet

The Technical Assistance Network for Children’s Behavioral Health released an extensive toolkit that measures various beliefs around healthcare (Concha et al., 2014).

This 33-item questionnaire was designed to measure questions around health care relating to community, spiritual care, family, knowledge of illness, perceptions of health care practitioners, service delivery, and community.

It is quite extensive and can guide practitioners in uncovering any beliefs or attitudes that might be preventing a client from seeking or persisting in their health care journey. The worksheet is available at the University of Florida website.

SMART goals

To help clients meet their goals, practitioners can guide clients through a goal-setting exercise based on the principles of the health belief model. For example, encourage them to set specific, measurable, achievable, relevant, and time-bound (SMART) goals related to improving their health behaviors.

In this exercise, practitioners can help clients identify strategies to address perceived barriers and enhance the perceived benefits of adopting healthier habits.

Here are two worksheets to help you.

• The first worksheet helps you and your client identify the important questions needed to achieve their goals.
• The second worksheet is a condensed version of the first and can be used to track multiple goals. The second worksheet is useful once your client understands the SMART process.

Decisional balance worksheet

When helping clients make a decision about their health behaviors, practitioners can use a decisional balance worksheet to help clients weigh the pros and cons.

Ask clients to list the advantages and disadvantages of adopting healthier behaviors, considering factors such as perceived benefits, perceived barriers, and the potential outcomes of their actions. This list will help clients gain insight into their own beliefs, make informed decisions, and prioritize goals.

In this decision-making worksheet, clients are asked to list the different options available to them and list the pros and cons associated with each.

If you want to help your client evaluate their past decisions so that they can identify which decisions were good and bad, then the Behavior Self-Evaluation worksheet will help you. Clients are asked to identify previous decisions, evaluate the outcome, and decide whether they would change their decision and why.

By integrating these worksheets and interventions into coaching or counseling sessions, practitioners can effectively apply the principles of the health belief model to support clients in achieving their health and wellness goals. Practitioners will need to adapt existing tools, questions, and worksheets to individual clients to ensure its appropriateness.

A Take-Home Message

The health belief model is a useful framework for making sense of why we choose whether to participate in certain health behaviors.

With this framework, practitioners can isolate and explore different aspects of clients’ decision-making processes, help clients gain insight into their behavior, and identify the challenges they experience with implementing positive change.

Although the health belief model is not applicable to every situation, it can still be leveraged to gain insight. Remember that change will not be immediate. Help manage your clients’ expectations; small changes are not always visible, but they add up over time.

Before you go, make sure to read these posts about changing behavior in your clients.

• What Is Behavior Change in Psychology? 5 Models and Theories
• How to Change Self-Limiting Beliefs According to Psychology

Let us know in the comments if this post helped you gain insight into your own behavior or that of your clients.

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