The health-belief model

This model (and the similar protection-motivation model) attempts to explain how individuals will take action to avoid ill health. First, individuals must recognise that they are susceptible to a particular condition (‘at risk’), and must perceive that the severity of the condition is such that it is worth avoiding.

They must also perceive that the benefits of avoidance are worth the effort of changing their behaviour and the possible adverse effects of the change (e.g. an alcoholic losing friends when they stop drinking). Finally, they must perceive that they have the self–efficacy (in terms of skills, assertiveness, etc.) to change their behaviour. (Self-efficacy is ‘functional self-confidence’: it is a person’s confidence that they will accomplish a specific task.) Cues to action are considered important in assisting all stages of change in this model. A cue for action could be a poster, a face–to–face encounter with an outreach worker or a conversation with a friend.

Rosenstock1 argues:

“Programs to deal with a health problem should be based in part on knowledge of how many and which members of a target population feel susceptible to AIDS, believe it to constitute a serious health problem and believe that the threat could be reduced by changing their behaviour at an acceptable psychological cost.”

The attraction of this model is that responses to cues to action at each of the theorised stages are easily measurable by surveys of knowledge and attitudes and of self–reported behaviour. However, the model is strongly biased towards explaining the success of information-giving, and measuring its impact through knowledge and attitudes surveys. It does not offer much insight into long–term sustenance of behaviour change, and allows sexual and drug-using behaviour to be framed in terms of ‘relapse’ if it does not conform to the model of behaviour change offered to the target audience. The notion of relapse assumes that behaviour change is a once-and-for-all event rather than an evolution which requires ‘sustenance’ and support, and does not take into account new situations in which previous learning will be inappropriate. An example might be the decision to abandon condom use in a relationship, which can be more fully explained by the ‘reasoned action’ model discussed below.

The model does offer some useful tools for questioning assumptions embedded in HIV prevention. For example, it can often come as a surprise to those involved in HIV prevention to discover that members of the target audience consider the consequences of HIV infection to be less serious than other outcomes (such as demonstrating a lack of trust in a partner or a loss of sexual pleasure from condom use). Rosenstock argues that behaviour change is most likely to occur in circumstances where severity and susceptibility are rated highly by individuals.

The health-belief model of individual behaviour change has been criticised for its lack of reference to the social and interactive context in which individuals come to judge their susceptibility to risks. In particular, critics have argued that it makes no reference to the pressures from peers or partners that may encourage risky behaviour. The social learning model discussed immediately below grew out of the health-belief model during the 1970s and 1980s as educators began to appreciate its limitations for explaining how and why people change their behaviour, and the need for concentrating on the development of skills or cognitive techniques.

One earlier meta-analysis2 found that there was no association between a person’s perceived vulnerability to HIV and the care they took to have safer sex. And, as seen above, interventions that attempted to reinforce the threat of HIV were generally counter-productive.

References

  1. Rosenstock IM et al. The Health belief model and HIV risk behaviour change in Preventing AIDS: theories and models of behavioural interventions. DiClemente RJ & Peterson JL (Eds), Plenum Press, New York, 1996
  2. Gerrard M et al. Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin, 119, 390-409, 1996
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.