Theories of Health Belief

Theories of Health Belief

·         HEALTH BELIEF MODEL: Becker, 1978.

·         LOCUS OF CONTROL: Rotter, 1966 OR Wineman, 1980

·         SELF-EFFICACY: Bandura and Adams, 1977

THEORY: HEALTH BELIEF MODEL

The health belief model is a working model that attempts to explain and predict health behaviours by focussing on the attitudes and beliefs of individuals. It was developed in the 1950’s by social psychologists (Hockbaum et al.). The core assumptions of this model is that someone will do a health related action if they believe a negative health condition is avoidable, can be avoided by completing the health related action, and that they feel they will be able to successfully complete the action. The model refers to constructs representing perceived threats and benefits that result in the final decision: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy.

STUDY: BECKER (1978) Compliance with a medical regimen for asthma

Becker conducted a correlational study to test the health belief model on asthma prevention medication. A sample of 111 mothers aged 17 to 54, with asthmatic children aged between 9 months and 17 years, took part in 45 minutes interviews, in which the mothers were asked about compliance, perceptions of susceptibility, seriousness of conditions, interference with education, embarrassment, interference with mother, effectiveness of medication and faith in doctors. Compliance was checked by blood tests of children, taken under the precedent that it was for medical rather than research reasons. Positive correlations were found between compliance and the following factors: susceptibility to attacks, seriousness of condition, interference with own activities, education and marital status. Negative correlations were found between compliance and disruption, inaccessibility to chemists, and complaints. It was concluded that the HBM was accurate in compliance with the medical regimen for asthma.

THEORY: LOCUS OF CONTROL

The locus of control refers to someone’s belief about what causes the good and bad results in their life. The locus of control is a scale from high internal locus of control, the belief that it is the individual is the main cause of their behaviour, actions and situations, to high external locus of control, where the individual will primarily believe that powerful others, fate, or chance strongly determine events, and they are largely out of their control. Those with high internal locus of control will think that they can influence others and their own lives with their actions; they think that their efforts will be successful, and they are active in seeking information – they will blame themselves both for positive and negative outcomes. Alternatively, those at the other end of the scale will often feel stressed out or overwhelmed, and may be prone to laziness, clinical depression or obesity as they believe what will happen, ultimately will happen.  

EVALUATION: this theory has not been strongly supported by later research, especially in terms of eating habits, for example, see Wineman (1980). Therefore, this theory may be limited in its applications and is not wholly nomothetic. This is an overly reductionist theory, which may be why it does not work in terms of complex health behaviours, such as eating habits. It is situational versus dispositional. It largely relies on self-report to gain information in order to determine locus of control, and self-report has issues with internal validity such as dishonesty, memory bias and social desirability.

STUDY: ROTTER (1966)

Rotter conducted a review article study into internal versus external locus of control. Initially, he used six pieces of research into individual perceptions of ability to control outcomes. Rotter found that the studies’ findings consistently showed that participants who felt they had control over the situation were more likely to show behaviours that would enable them to cope with potential threats than participants who thought that chance or other non-controllable forces determined the effects of their behaviours. In other words, he found that those with an internal locus of control appeared to be more prepared against danger than those with an external locus of control. Rotter concluded that locus of control would affect many behaviours, including health behaviours, as those with an external locus of control were likely to be less pro-active in avoiding health risks. He included in his study research by James et al, which found that male smokers who gave up smoking and did not relapse had a higher locus of control than those who did not quit. However, there wasn’t a significant difference for female smokers.

STUDY: WINEMAN (1980)

Wineman conducted a cognitive study to investigate locus of control, body image and weight loss in a self-selected sample of 116 adult members of Overeaters Anonymous (OA). Most of these were female, all were Caucasian, and they were from a range of social class backgrounds. He conducted a self-report study using retrospective correlation. Three questionnaires were given out: a demographic questionnaire, which featured questions about age, sex and age at onset of obesity; Rotter’s Social Reaction Inventory Scale, 29 forced choice questions measuring internal and external locus of control; and Secord and Jourad’s Body Cathexis Scale, which used five-point Likert scales to measure body satisfaction. The results showed that of the 116 participants, 59% had childhood onset of obesity. Multiple regression analysis was performed at three onset age categories (childhood, adolescence and adult) separately to analyse the relationship between locus of control and weight loss. Locus of control significantly predicted body image in the adult group but there was no correlation between either body image or weight loss in the sample overall. Body image and weight loss correlated in the adolescence group. Males had overall higher body satisfaction and greater weight loss. Wineman concluded that external cues may influence a person’s eating habits specifically yet not be reflected in general locus of control beliefs, and from this she concluded the Rotter scale was not a suitable measure of locus of control with regards to eating habits.

THEORY: SELF-EFFICACY

Self-efficacy refers to a person’s perceptions of their ability in a particular situation. It is at the heart of Bandura’s social cognitive theory, and according to Bandura, someone’s attitudes (including self-efficacy), abilities and cognitive skills comprise what is known as the self-system, which plays a major role in how we perceive different situations, and how we behave in response to these situations. He described self-efficacy as a determinant of how people think, behave and feel (1994), and demonstrated that self-efficacy impacts everything from psychological states to behaviour, to motivation. Self-efficacy is believed to begin in early childhood and evolve throughout life: the four main sources are mastery experiences, social modelling, social persuasion, and psychological responses. People with a strong sense of self-efficacy tend to view challenges as tasks to be mastered, and recover quickly from setbacks and disappointments, whilst people with a weak sense of self-efficacy avoid challenging tasks, quickly lose confidence, and focus on failures.

STUDY: BANDURA AND ADAMS

This study aimed to assess the self-efficacy of patients undergoing systematic desensitisation in relation to their behaviour with previously phobic objects.

It was a controlled quasi-experiment consisting of 10 self-selected patients with snake phobias. There were nine females and one males, aged 19-57 years.

The first part of the procedure was a pre-test assessment: each patient was assessed for avoidance behaviour towards a boa constrictor, then fear arousal was assessed with an oral rating of 1-10 and finally efficacy expectations (how well they thought they will be able to perform different behaviours with the snake). Their fear of snakes was also measured on a scale, along with their own rating on how effectively they would be able to cope.

They then underwent the behavioural therapy of systematic desensitisation: a standard programme was followed where patients were introduced to a series of events involving snakes and each was taught relaxation. These ranged from imagining looking at a picture of a snake to handling a live snake. Post-test assessment: each participant was again measured on behaviours and belief of self-efficacy in coping.

The findings showed higher levels of post-tests self-efficacy were found to correlate with higher levels of interaction with snakes, and thus it was concluded that desensitisation enhanced self-efficacy levels, which in turn led to a belief that the participant was able to cope with the phobic stimulus of a snake.