INTEGRATED MODELS
Attribution theory and the health locus of control model emphasize attributions for causality and control, unrealisticoptimism focuses on perceptions of susceptibility and risk, and the stages of change model stresses the dynamic nature of beliefs, time, and costs and benefits. These different perspectives on health beliefs have been integrated into structured models. The health belief model The health belief model was developed initially by Rosenstock in 1966 and further by Becker and colleagues throughout the 1970s and 1980s (e.g. Becker et al., 1977). Their aim was to predict preventative health behaviours and the behavioural response to treatment in acutely and chronically ill patients. Over recent years, the model has been used to predict many other health-related behaviours. According to the health belief model, behaviour is a product of
a set of core beliefs that have been redefined over the years. The original core beliefs are the individual’s perception of: susceptibility to illness – ‘My chances of getting lung cancer are high’;
the severity of the illness – ‘Lung cancer is a serious illness’; the costs involved in carrying out the behaviour – ‘Stopping smoking will make me irritable’;
the benefits involved in carrying out the behaviour – ‘Stopping smoking will save me money’; and
cues to action, which may be internal (e.g. the symptom of breathlessness) or external (e.g. information in the form of health education leaflets).
The health belief model suggests that these core beliefs are used to predict the likelihood that a behaviour will occur. In response to criticisms, the model was revised to add the construct health motivation to reflect readiness to be concerned about health matters (‘I am concerned that smoking might damage my health’). More recently, Becker and Rosenstock (1987)suggested that perceived control (‘I am confident that I can stop smoking’) should also be added to the model. When applied to a health-related behaviour such as screening for cervical cancer, the health belief model predicts that someone is likely to have regular screening if she perceives that:
1. she is highly susceptible to cancer of the cervix;
2. cervical cancer is a severe health threat;
3. the benefits of regular screening are high; and
4. the costs of such action are comparatively low.
There will also most likely be relevant cues to action – either external (such as a leaflet in the doctor’s waiting room) or internal (such as pain or irritation, which she perceives to be related to cervical cancer). The new, amended model would also predict that a woman is more likely to attend for screening if she is confident that she can do so, and she is motivated to maintain her health. The protection motivation theory Rogers (1975, 1983, 1985) developed the protection motivation theory (figure 19.3), which expanded the health belief model to include additional factors.
Attribution theory and the health locus of control model emphasize attributions for causality and control, unrealisticoptimism focuses on perceptions of susceptibility and risk, and the stages of change model stresses the dynamic nature of beliefs, time, and costs and benefits. These different perspectives on health beliefs have been integrated into structured models. The health belief model The health belief model was developed initially by Rosenstock in 1966 and further by Becker and colleagues throughout the 1970s and 1980s (e.g. Becker et al., 1977). Their aim was to predict preventative health behaviours and the behavioural response to treatment in acutely and chronically ill patients. Over recent years, the model has been used to predict many other health-related behaviours. According to the health belief model, behaviour is a product of
a set of core beliefs that have been redefined over the years. The original core beliefs are the individual’s perception of: susceptibility to illness – ‘My chances of getting lung cancer are high’;
the severity of the illness – ‘Lung cancer is a serious illness’; the costs involved in carrying out the behaviour – ‘Stopping smoking will make me irritable’;
the benefits involved in carrying out the behaviour – ‘Stopping smoking will save me money’; and
cues to action, which may be internal (e.g. the symptom of breathlessness) or external (e.g. information in the form of health education leaflets).
The health belief model suggests that these core beliefs are used to predict the likelihood that a behaviour will occur. In response to criticisms, the model was revised to add the construct health motivation to reflect readiness to be concerned about health matters (‘I am concerned that smoking might damage my health’). More recently, Becker and Rosenstock (1987)suggested that perceived control (‘I am confident that I can stop smoking’) should also be added to the model. When applied to a health-related behaviour such as screening for cervical cancer, the health belief model predicts that someone is likely to have regular screening if she perceives that:
1. she is highly susceptible to cancer of the cervix;
2. cervical cancer is a severe health threat;
3. the benefits of regular screening are high; and
4. the costs of such action are comparatively low.
There will also most likely be relevant cues to action – either external (such as a leaflet in the doctor’s waiting room) or internal (such as pain or irritation, which she perceives to be related to cervical cancer). The new, amended model would also predict that a woman is more likely to attend for screening if she is confident that she can do so, and she is motivated to maintain her health. The protection motivation theory Rogers (1975, 1983, 1985) developed the protection motivation theory (figure 19.3), which expanded the health belief model to include additional factors.
The original protection motivation theory claimed that healthrelated behaviours are a product of, and therefore predicted by, five components:
1. severity – ‘Bowel cancer is a serious illness’;
2. susceptibility – ‘My chances of getting bowel cancer are high’;
3. response effectiveness – ‘Changing my diet would improve my health’;
4. self efficacy – ‘I am confident that I can change my diet’; and
5. fear – ‘Information about the links between smoking and lung cancer makes me feel quite frightened’.
The protection motivation theory describes severity, susceptibility and fear as relating to ‘threat appraisal’ (i.e. appraising an outside threat), and response effectiveness and self efficacyas relating to ‘coping appr aisal’ (i.e. appraising the individual themselves). According to the theory, there are two types of information source: environmental (e.g. verbal persuasion, observational learning) and intrapersonal (e.g. prior experience). This information influences the five components listed above, which then elicit either an adaptive coping response (a behavioural intention) or a maladaptive coping response (such as avoidance or denial). If applied to dietary change, the protection motivation theory would make the following predictions. Information about the role of a high fat diet in coronary heart disease would increase fear, increase the individual’s perception of how serious coronary heart disease was (perceived severity) and increase their belief that they were likely to have a heart attack (perceived susceptibility). If the individual also felt confident that they could change their diet (self efficacy) and that this change would have beneficial consequences (response effectiveness), they would report high intentions to change their behaviour (behavioural intentions). This would be regarded as an adaptive coping response to the presented information.
1. severity – ‘Bowel cancer is a serious illness’;
2. susceptibility – ‘My chances of getting bowel cancer are high’;
3. response effectiveness – ‘Changing my diet would improve my health’;
4. self efficacy – ‘I am confident that I can change my diet’; and
5. fear – ‘Information about the links between smoking and lung cancer makes me feel quite frightened’.
The protection motivation theory describes severity, susceptibility and fear as relating to ‘threat appraisal’ (i.e. appraising an outside threat), and response effectiveness and self efficacyas relating to ‘coping appr aisal’ (i.e. appraising the individual themselves). According to the theory, there are two types of information source: environmental (e.g. verbal persuasion, observational learning) and intrapersonal (e.g. prior experience). This information influences the five components listed above, which then elicit either an adaptive coping response (a behavioural intention) or a maladaptive coping response (such as avoidance or denial). If applied to dietary change, the protection motivation theory would make the following predictions. Information about the role of a high fat diet in coronary heart disease would increase fear, increase the individual’s perception of how serious coronary heart disease was (perceived severity) and increase their belief that they were likely to have a heart attack (perceived susceptibility). If the individual also felt confident that they could change their diet (self efficacy) and that this change would have beneficial consequences (response effectiveness), they would report high intentions to change their behaviour (behavioural intentions). This would be regarded as an adaptive coping response to the presented information.
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