A meta analysis of the effectiveness of health belief model variables in predicting behavior
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“ A meta-analysis of the effectiveness of health belief model variables in predicting behavior”. Carpenter, 2010. Natalie Linton Oregon State University October 9, 2014. What is the Health Beliefs Model (HBM)?. Developed by the U.S. Public Health Service in the 1950s

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A meta analysis of the effectiveness of health belief model variables in predicting behavior

A meta-analysis of the effectiveness of health belief model variables in predicting behavior”

Carpenter, 2010

Natalie Linton

Oregon State University

October 9, 2014


What is the health beliefs model hbm
What is the Health Beliefs Model (HBM)?

  • Developed by the U.S. Public Health Service in the 1950s

  • Based in value-expectancy theory

measles

http://xkcd.com/51/


What is a meta analysis
What is a meta-analysis?

  • Statistical methods for contrasting and combining results from different studies

  • Meta-analyses can identify:

    • patterns

    • sources of disagreement

Previous HBM meta-analyses:

  • Janz & Becker 1984

    • barriers, benefits, susceptibility

    • did not estimate mean effect sizes

  • Harrison et. al. 1992

    • retrospective studies = larger effect sizes than prospective

    • did not correct effect size estimates

  • Zimmerman & Vernberg 1994

    • HBM prediction weak compared to Social Cognitive Theory and TRA

    • did not examine the effects of each variable on behavior


Why did carpenter conduct a meta analysis of the hbm
Why did Carpenter conduct a meta-analysis of the HBM?

  • Determine whether measures of HBM concepts could longitudinally predict behavior

  • Which elements are strong predictors?

  • What are the moderators?

  • Moderators found:

    • Time between variable measurement (Time 1) and outcome behavior measurement (Time 2)

    • Type of outcome behavior:

      • Prevention or treatment

      • Drug-taking or not drug-related


Methodology
Methodology

  • 18 studies (2,702 subjects); published 1982-2007

  • Looked at only the first 4 concepts of HBM:

    • Susceptibility (18), severity (17), barriers (17), benefits (15)

    • Studies had to include at least 2 of the 4

  • Studies had to be longitudinal

    • Time 1: measure HBM variables

    • Time 2: measure health-related behavior outcome

  • Outcome dichotomizedas treatment (8 studies) or prevention behavior (10 studies)

  • Outcome also dichotomized as drug-taking behavior (5 studies) or other behavior (13 studies)




Perceived susceptibility
Perceived susceptibility

  • Usually not correlated with health behavior (weakest predictor)

  • Estimates mostly homogenous

  • Subset of drug-taking studies only set for which susceptibility was positively correlated with behavior

  • Moderator: length of time

    • Longer periods of time between Time 1 and Time 2 associated with weaker effects

    • r = -0.50


Perceived severity
Perceived severity

  • “There is something about about considering complying with a prescription to take drugs that causes people to consider the severity of the consequences for not taking the drugs more so than for other health behaviors”

  • Moderator: length of time

    • Severity ratings more likely to be positively correlated to behavior if the behavior is measured shortly after Time 1

    • r = -0.37


Perceived benefits and barriers
Perceived benefits and barriers

  • Strongest predictors of behaviors

    • Stronger when dealing with preventive behavior

  • Findings mostly consistent with previous literature

  • Moderator for perceived benefits: length of time

    • Longer periods of time between Time 1 and Time 2 associated with weaker effects r = -0.59

http://xkcd.com/388/


Limitations
Limitations

  • Small number of studies

  • Not enough articles providing effect sizes

  • Variety and varying quality of measures used

  • 16 (of 18) articles relied on convenience samples

  • Did not test more complex models that are possible and would be better to test (studies would have needed to report full correlation matrices)


Levels of

Causation

Ultimate

CULTURAL

SOCIAL

BIOLOGY/

Causes

ENVIRONMENT

SITUATION

PERSONALITY

1

2

3

4

5

6

a

f

Social/

Personal

Nexus

c

d

e

b

Sense of

Information/

Interpersonal

Others’

Social

Interactions w/

Self/Control

Opportunities

Bonding

Beh & Atts

Competence

Social Instit’s

Distal

Influences

7

8

9

10

11

12

g

r

p

i

q

h

k

n

m

l

j

o

Expectancies

& Evaluations

Self

Skills:

Motivation

Perceived

Values/

Knowledge/

Determination

Social+General

to Comply

Norms

Evaluations

Expectancies

13

14

15

16

17

18

s

x

ATTITUDES

SOCIAL

SELF-EFFICACY

u

w

v

t

Affect and

Cognitions

TOWARD THE

NORMATIVE

BEHAVIORAL

BEHAVIOR

BELIEFS

CONTROL

Proximal

19

20

21

Predictors

Decisions

A

G

B

H

C

I

D

E

F

22

K

Experiences

23

Related Behaviors

J

Intrapersonal Stream

Social/Normative Stream

Cultural/Attitudinal Stream

Biological/Nature

Nurture/Cultural

DECISIONS/INTENTIONS

Trial Behavior

EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological


Discussion
Discussion

  • Why do you think Carpenter found perceived susceptibility to have almost no relationship to health behavior?

  • Why do you think time between measures worked as a moderator for susceptibility, severity, and benefits?

  • Why was time between measurements not a moderator for barriers?


References
References

  • Christopher J. Carpenter (2010): A Meta-Analysis of the Effectiveness of Health Belief Model Variables in Predicting Behavior, Health Communication, 25:8, 661-669.

  • DiClemente, R.J., Salazar, L.F., & Crosby, R.A. (2013). Health Behavior Theory for Public Health: Principles, Foundations and Applications. Jones and Bartlett, Boston, MA.

  • TTI slides provided to H 571 class at Oregon State University.


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