It is known that the concern of psychological practice in the experience of health and illness has become greatly acknowledge in the last two decades. This is due to medical, immunological and pharmacological reasons. These categories have helped, due to their advancement to control some of the major acute diseases. In around the western hemisphere heart disease, cancer and stroke has been the main culprit of premature death amongst the people. These culprits or conditions are usually influenced by our lifestyle factors. Dues to the increase of chronic diseases and illnesses in the last two decades we have seen the development of several behavioral techniques and research in attempts specifically directed towards lifestyle modification.
One of the behavioral techniques is called the Health Belief Model (HBM). It declares that decision in whether or not to engage in health related behaviors. The core focus in this model is the individual’s perception of the threat posed by the illness of behavior stemming from the perceived vulnerability and the severity of the disease. The instance of any action only occurs after the individual appraises the benefits of preventive action minus the perceived barriers such as cost, time and effort required in the health behaviors.
Hence, it is widely recognized that lifestyle plays an important role in illness and on the country positive modification in our lifestyle are a major factor in health promotion and disease prevention, Jeffery, 1989 (as cited in Bennette, 2000). It is hard to assess the extent to which each factor of lifestyle poses a threat to an individual health because most our lifestyles do tend to occur together. Each factor may carry its own value hence may have greater risk than others (for example, unprotected sex can be a risk factor for HIV and AIDS). Also health consequence of different behaviours tends to reveal at different times. For example, the effect of smoking may not reveal it effects for at least twenty to thirty years. Prevention is better than a cure. Thus the HBM attempts to understand change of such behavior example smoking to not smoking, to predict if people will stop engaging in a form of compromising heath behavior.
Smoking is a form of compromising health behaviour, so can HBM help one to give up smoking? According to this model it should be able to because this model considers the internal factor, such as the perception of the symptom. It also takes into consideration the external factor, such as a health education message. These factors will enable an individual to determine if the behavior should be performed. For example Johnson and Heller 1998, ( as cited on Benntte, 2000) found that cardiac patients who considered exercise to be worthwhile to their health while in hospital were most likely to be following a regime six month later.
This study takes into account the external and internal factor of HBM making it a success but as we know that an individual perception may cloud this judgment and on the other hand if the patients saw to many potential barriers to the regime they would be less likely to engage in the exercise later. But smoking may be perceived as being positive factor because while they are unaware that they are causing damage to their health they at the same time observe in others that it can be a rewarding and pleasurable behavior. They preserver expectation of future pleasure only until the perceived image is replaced with health education. From the HBM individuals perceives that they are less susceptible to illness. This might change their behaviors if there is a fear arousing behavior message.
They might be susceptible to the addiction and they may find the key between protective behaviors and able to reduce the addiction. But I think transtheorectical model is much more appropriate for someone willing to give up smoking, as it will be discussed later. From the HBM, perceived vulnerability is tested. We understand that negative behaviours can be associated with a positive perceived outcome but if the negative behaviour were replaced with negative outcome then maybe the individual would give up smoking due the negative information advertised. Sturges and Rogers 1996, (as cited in Bennette, 2000), tested this notion by appealing to young adults about the threats of smoking with the increased intention not to smoke.
They used this programme when they believed that they could successful in giving up smoking. But if they did not believe this notion then more intensed threats were published resulting in intention to refrain from smoking. But despite taking into account of individual’s perspective, it was a success. This was cautiously followed by Boer and Seydel, 1996 (as cited in Bennette, 2000), whose leaflet were distributed by highlighting the high risk of breast cancer in older women so that they would attend mass screening clinic. They concluded that when they eliminate the taboos surrounding the screening, they saw a high percentage of patients.
The model takes into consideration the attitudes and the beliefs for cues for action, consequence in decision process. These beliefs form a post hoc explanation as Bennette and Clatworthy illustrated in their 1999 research. They tested this on women who will and would not stop stopping while they were pregnant. They concluded that women who continued to smoke did not acknowledge that there was a threat to the unborn child. But these women still smoked but their level of smoking decreased despite holding onto their own set of beliefs. So what does this suggest? Well the model does not take into consideration that people can become additive to smoking but yet they can hold beliefs which are same as those who want to give up smoking.
For one to give up smoking using the HBM is simply moving from A to perceiving Z and in between A to Z is the reducing agents called promotion or programmes used for us to reach the goal of Z. So we can assume that it is easy to give up smoking? Well some studies do not tend to agree to this notion as Sorensen et al (1998) discovered. This study links with the HBM in that the perceived susceptibility to illness and actions are used to for the decision process of giving up smoking. It was called the Wellworks programme were the worker/management members interacted in the health education programme. It was a slight success because some individuals were able to give up smoking but there was not a significant reduction. But according to the HBM this method should work, is that right? It should work according to Harris (1996).
On paper the programme is underpinned from the HBM so this should be a success but in practice, measuring the impact and health promotion activity is not as easy job. The programme is not mandatory and also there might be poor measurement. Thus the HBM is good at designing intervention models as illustrated but it does not account for measurement of the impact. As mentioned previously the core component of HBM included the individuals’ perception of the threat posed by the future illness but taking this principle in the workforce and applying it. This would mean that have to consider individuals attitudes towards smoking as one may influence another that the risk of illness is small. A negative factor influencing a neutral perception
HBM has had a positive impact on some individual people in helping one to be aware of illness and also to give up smoking to prevent further damage to health. But despite this Leventhal et al, 1985 (as cited in Bennette 2000), argued that individuals factor in HBM do not promote health behaviours but instead that the perceived symptoms of the potential illness is more powerful.
As illustrated by several intervention programme. It fails to take into account the environmental or social factors that may influence decision making as illustrated by Glasgow et al (1995). It assumes that a person will be able to engage in health beaviour if they wish, therefore neglecting their cultural determinants that can affect participants in a health related behaviour. Also nowhere in this model is there a category which considers the effects of emotions such as fear, leading to denial. So the model is seen a static in its approach to behaviours change because it assumes that a person can move forward from A to Z.
But the Transtheorectical Model considers the position from A to Z with the consideration that you can either move forward of backwards. For example a smoker could reach maintenance but return to precontemplation in the future (stop smoking and then start again a year later). The model acknowledges that not everyone is ready for a change and we do not always start from A.
As Protection Motivation Theory (PMT) attempts to take into consideration. It expands on HBM because it includes appraisal of severity and coping. PMT was used as behaviours of breast self examination (BSE). Orbell (1998) used BSE to evaluate PMT to predict behaviours; they found it to be linked with coping appraisal but not with threat. But PMT does not take into consideration habit-forming behaviors. Hence it begs the question, where has it gone wrong? As mentioned, it assumes humans are rational information processes.
As Flower et al 1997 (as cited in Bennette 2000), suggested that it is not the case in moments of extreme heighten emotion. But it seems that self-efficacy was the central determinants of behaviours because it reduces the perceived barriers. Action-outcome is better than situation outcome e.g. illness. This is due to because a person’s action is fundamental to the specific outcome. Thus researchers are realizing that health related behaviours take place in context.
In summary, there are now several reasons to why the models do not contribute to our understanding of why people engage in health compromising behaviours and why the HBM may be effective on some people and not others. Smokers do not exist alone in a vacuum as assumed by the models. But despite the model failing, the contribution made will be useful and instrumental in the developing of the future health related models.
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