Health Belief Model: Key Points and Application

1. Health Education Models Cathy Hollister, RDH, MSPH, PhD Nashville Area Dental Support Center Director United South and Eastern Tribes, Inc. 615-872-7900 mary.hollister@ihs.gov

2. Health Belief Model • First model that recognized a social component to health • See Nathe, C.N. (2001). Dental public health: contemporary practice for the dental hygienist. Upper Saddle River, NJ: Prentice-Hall, Inc. • Theoretical Base • Better informed people will make better choices

3. HBM: Key Points • Individuals must believe they are susceptible to the problem • Example: Mothers must believe their children are susceptible to caries • Individuals must believe the condition is serious • Mothers must believe baby teeth are important

4. HBM: Key Points- Con’t. • Individuals must believe the intervention will work • Mothers must believe sleeping with the bottle contributes to ECC • Mothers must believe reducing exposure to sugars will reduce risk of ECC • Individuals must overcome barriers • Parents must be willing to endure crying • Parents must have strategies to overcome “grandma overindulgence”

5. Limitations of HBM • Information alone rarely leads to a behavior change • Behavior changes are not linear • Doesn’t provide the tools needed for behavior change

6. New Diseases or Threats • TSA • Susceptible • Global threat from terrorists • Airlines have been targets • Serious • Interventions work • Effective screening techniques • Complaints about male/female screeners • Overcome barriers • Accommodate male/female travelers • More screening stations • Consider flight times

7. Stages of Change • Behavior is change happens in stages • Change is predictable and follows a pattern

8. Stages • Precontemplation • No interest in change • Contemplation • Ready to change but no change has started • Preparation • Arranging elements necessary for change

9. Stages • Action • Change has started • Maintenance • Change has been sustained for 6 months • Termination • As if the previous behavior never existed

10. Smoking Cessation • Pre-contemplation • No interest in quitting tobacco use • Contemplation • Interested in quitting but not yet ready. • Gather information • Consider heatlh consequences • Discuss personal experiences of experiences of others

11. Smoking Cessation • Preparation • Set a quit date • Enroll in a smoking cessation program • Purchase quit aids • Plan strategies for quitting and triggers • Action • Quit using tobacco • Actively work on behavior change • Devise strategies for maintaining behavior

12. Smoking Cessation • Maintenance • No tobacco use for 6 months • Termination • No desire for tobacco

13. Theory of Reasoned Action • People make rational decisions based on knowledge, values and attitudes • Intentions predict behavior • Limited value because intentions change quickly

14. Theory of Reasoned Action • Social Norms influence behavior • Social norms formed within a family, community or society • More use of Bottled water • Oral health habits formed in families, Head Start

15. Reasoned Action: What is Missing? • Information • Facts • Personal assessment • Readiness to change

17. Social Learning Theory • LOC and Self Efficacy are Modifications of Social Learning Theory Behavior Environment Knowledge

18. Locus of Control • Refers to an individual’s beliefs about control over health or health actions • External • Health status is influenced by fate, luck, chance or other people

19. Locus of Control • Internal • Health status is controlled by personal behavior • One of several factors that determine health behaviors • LOC is an indirect measure of health status

20. Locus of Control • LOC and Self-efficacy were associated with ECC in studies of Head Start children • Reisine & Litt, 1993 • Increased risk of ECC • External LOC • Lower income • More knowledge about dental health • Higher stress

21. Self Efficacy • High SE means an individual has confidence their actions will affect outcome • Involves forethought, preplanning, sense of control • Higher self efficacy is frequently associated with better health status 

22. Self Efficacy • Attained by: • Enactive Attainment (Success breeds success) • Vicarious Learning • Verbal persuasion • Associated with oral health in multiple studies

23. Confidence vs Self-Efficacy • Confidence: I can do it • Self-Efficacy: If I do it, my life will change

24. Sense of Coherance • Salutagenesis • What keeps people well? • Continuum of “ease to dis-ease” dis-ease -----------------------------------------ease ↑

25. Sense of Coherence • Network of resources creates system for managing stress • Health status is predictable • Adequate resources to manage health • Health is important enough to spend resources • Higher SOC associated with better oral health (Friere, Hardy & Sheiham, 2002)

26. Sense of Coherence • Oral Health Network • Access to care • Trusted dentist • Access to healthy foods • Belief that oral health is important • Source of accurate information

28. HPV Vaccinations • UNC Researchers • Interviewed Parents of young girls about the vaccine • Likely to get vaccine • Expressed regret at the thought that their daughter might develop later cervical cancer

29. Barriers • Less likely to get vaccine if: • Didn’t know where to get it • Insurance didn’t cover vaccine • Health care providers didn’t have the vaccine • Born again Christians less likely to get vaccine

30. HPV Vaccine Health Message “You have hopes and dreams for your daughter, and they don’t include cervical cancer”