CHAPTER 2: LITERATURE REVIEW
2.8 Theoretical framework
described in terms of the individual’s estimates of personal susceptibility to and perceived severity of an illness, as well as the likelihood of being able to reduce that threat through personal action (Champion and Skinner, 2008).
The health belief model focuses on two aspects of individuals representations of health and health behavior: threat perception and behavioral evaluation (Abraham and Sheeran, 2005). Threat perception is interpreted as two key beliefs, the first one is the individuals self-predicted likelihood to acquire an illness or health problems(Perceived susceptibility); the second is the intensity of the consequences of an illness(perceived severity). Behavioral evaluation also consists two sets of beliefs, the first one concerns the benefits or effectiveness of a recommended health behavior (Perceived benefits), the second belief concerns the cost of, or barriers to enacting the health behavior (Perceived barriers) (Abraham and Sheeran, 2005).
Perceived susceptibility suggests held beliefs about the possibility of an individual to get a disease or health condition, and this held belief is likely to prompt an action. For example; a women must believe there is a possibility for her to get cervical cancer, before she will be interested in doing a Pap Smear (cervical cancer screening) (Champion and Skinner, 2008).
Perceived severity explains how the individual views the seriousness of getting an illness, or leaving it untreated and the consequences they have to face as a result of that negligence. Possible consequences commonly thought of are pain, disability and even death. Some are less of a physical nature but are more social, such as the effects of the conditions of work, family life as well as social relations. This perceived severity, combines with perceived susceptibility is labeled as a perceived threat (Skinner, Tiro & Champion, 2015).
When an individual identifies a perceived threat, this could be through identifying a personal perceived susceptibility to a serious health condition, the individual’s beliefs which pertain to their perceived benefit of available health behaviors or actions to reduce the disease or threat will be greatly influence the possibility of the individual’s actual behavior change. Perceived benefits can be those of a non-health related nature. For example a person may decide to quit drinking alcohol to save money. So the action of quitting is motivated by a non physical/ non health perceived benefit (Deshpande, Basil & Basil, 2009).
Perceived barriers are potential negative aspects of a particular health action. These may serve as impediments to undertaking recommended behaviors. When an individual considers the expected
benefits of an action versus the perceived barriers, they subconsciously conduct a cost-benefit analysis, by comparing the benefit to the cost of the action (Champion and Skinner, 2008).
Cue to action refers to the activation of an individual’s perceived susceptibility and perceived benefit by an internal or external factor. These factors are referred to as cues which instigate action (Conner and Norman, 2005). An internal factor, could be experienced when an individual feels a symptom that increases a perceived threat, eg. A persistent cough and headache which is a symptom indicative of possible Covid 19 infection could be perceived as a cue for an individual to screen and maybe even test for Covid 19. An external cue is often times in the form of stimulation or information made available to an individual which triggers the feelings of perceived threats and benefits. Eg. A Billboard showing the dangers of smoking can serve as a cue to prompt a smoker to attempt quitting smoking due to health reasons.
Self-efficacy is the belief that one can successfully complete the behavior of interest despite the considered barriers (Jones et.al., 2015). It refers to an individual’s confidence in their ability to successfully perform a behavior which is required to produce a desired outcome (Nieuwenhuijsen et.al., 2006).
Figure 1 The health belief model
According to the health belief model, there are two main types of beliefs that influence individuals to take preventative action, beliefs related to readiness to take action and those related to modifying factors that facilitate or inhibit action (Nejad et.al., 2005). The health belief model is said to be different from other models because it does not have strict guidelines on how the different variables predict human behavior. It simply proposes that the independent variables are likely to contribute to the prediction of health behaviors, but lacks structure. According to Nejad et.al. (2005), though this lack of structure is often a source of criticism among researchers, health belief variables have been moderately successful in predicting variety of behaviors.
The variables of the health belief model may be summarized and tabled and possible intervention strategies proposed as per the illustration below.
Table 1: Health belief model variable summary and related intervention strategies
Critics of the Health Belief Model claim that not all health behavior is based on rational or conscious choice, as the theory suggests. The model has also been critiqued for focusing only on negative factors and ignoring positive motivations that prompt healthy behavior. It has also been said that the model focuses on individual factors, rather than socio economic and environmental factors that may prohibit or promote the recommended action (Raingruber, 2014). Limitations of the health belief model include the fact that it does not account for an individual’s attitudes, belief or other individual determinants that dictate a person’s acceptance of a health behavior. It also does not account for behaviors that are habitual and thus may inform the decision making process. It doesn’t take into account behaviors that are performed for non-health related reasons such as social acceptability. The health belief model assumes that everyone has the same amount of information. It also assumes that cues to action are widely prevalent in encouraging people to act and that “health”
actions are the main goal in the decision making process (LaMorte, 2019).
The main strength of the Health Belief Model is its use of simplified health-related constructs that make it easy to implement, apply and test. It has also provided a useful theoretical framework for investigating the cognitive determinants of a wide range of behaviors. The Health Belief Model has focused researchers on variables that are prerequisites for health behavior, hence it has formed a basis for many practical interventions across a range of behaviors (Orji, Vassileva and Mandryk, 2012).
The health belief model has been identified as suitable to guide this study. This theory will provide a useful framework for the investigation individual attitudes towards health services provided by the government. It will also provide a basis upon which lived experiences and behaviors may be probed.
This theory will provide justifications for the recommendations to be developed in this study, since it posits that people will take action if they believe that particular action available to them would reduce the susceptibility or severity or lead to other positive outcomes.