Most individuals think they make an effort to take care of their personal health. However, many might admit that there are ways they could do better, whether that means getting an annual flu shot, regularly exercising, or visiting their primary care physician for annual checkups. In practice, encouraging the public to proactively attend to their own health interests is more complicated than it may seem. The likelihood that individuals will take preventative measures to avoid illness, seek treatment for illnesses or medical conditions, and continue treatment for diagnosed health problems is mediated by a variety of factors, some situational, some psychological, some social, some cultural, and some political. For public health officials, health campaign workers, medical practitioners, and scholars, understanding these obstacles and devising strategies to overcome them is a key goal.
Of the theoretical models developed by scholars to attend to the challenges of patient education and motivation, the Health Belief Model has been one of the most influential and enduring. As Victoria Champion and Celette Skinner (2008) observe, the Health Belief Model (or HBM) has been applied in a diverse body of research to understand health-related behaviors, and used to support “interventions to change health behavior.” Put simply, the model holds that a person’s beliefs or cognitive judgements about factors related to their health behaviors, such as their perceived susceptibility to illness, perceived benefits of seeking treatment, and perceived barriers to receiving or maintaining care, influence the likelihood they will engage in behaviors that would support their health.
This article provides an introduction to the Health Belief Model and is designed for prospective students considering graduate studies and/or a career in health communication. After providing a brief history of the model’s innovation and development, the following sections discuss key constructs in the Health Belief Model, important areas of applied research using the model, limitations of the model, and finally, the state of contemporary research that employs the Health Belief Model.
A Brief History of the Health Belief Model
Researchers working for the U.S. Public Health Service developed the Health Belief Model in the 1950s in an attempt to explain and address the lack of public participation in disease protection and prevention programs. During this time, as Irwin M. Rosenstock (1974), one of the model’s innovators, notes, research at the Public Health Service was defined by its orientation toward the prevention of disease rather than its treatment and had a distinct “phenomenological orientation,” with the behavioral sciences still largely absent from public health scholarship at the time. The result was a model that was interested in the perceptual and cognitive structures that informed the individual’s relationship to health behaviors.
Since its innovation, the HBM has evolved to become one of the most widely adopted and diversely applied methods in health communication, public health, and health education research. Health communication scholars continue to employ the framework both on its own and in combination with other theoretical frameworks to understand health-related behaviors. In adapting this framework, researchers have applied the model in more varied contexts than it was originally designed for, mostly to great effect.
Originally the HBM was applied to promoting preventative actions like encouraging individuals to get vaccinated to prevent infections and illnesses, however, it is now applied to continuing treatments for chronic diseases and at-home individual practices of health maintenance, like keeping up with medication or physical therapy regimens. Further, researchers and practitioners have put the HBM to work in designing and analyzing public health initiatives both in the United States and internationally, including in campaigns that make use of different forms of media and technology, including television, film, and digital technologies.
Therefore, over several decades of scholarship, the HBM has expanded to grapple with a wider array of health behaviors and evolved to meet the opportunities and challenges that new media technologies present regarding how we communicate about health. At the same time, the key constructs that serve as the foundation for the model have gone largely undisturbed, though some have proven more salient than others. The following section reviews these constructs in more detail.
Spotlight on Scholarship - Featured Scholars Researching the Health Belief Model
Learn about contemporary scholars conducting innovative research with the Health Belief Model, from research on health campaigns to studies concerned with the role online communities play in encouraging patients to keep up with medical treatment.
Dr. Kellie E. Carlyle is Professor in the Department of Social and Behavioral Sciences and Interim Associate Dean for Academic Affairs for the School of Public Health at Virginia Commonwealth University (VCU). She has also served as the lead researcher for the Sexual and Domestic Violence Research Development Group in the Institute for Women's Health, among other important roles at VCU Her research on public health, which attends to health disparities, media representations of public health problems, and health messaging, was recognized with the 2015 Early Career Award from the American Public Health Association. Dr. Carlyle also received the 2018 Dale Brashers Distinguished Mentor Award from the Health Communication Division of the National Communication Association. Dr. Carlyle's research on the Health Belief Model includes her co-authored 2019 paper, "Using the Health Belief Model to Analyze Instagram Posts about Zika for Public Health Communications." Dr. Carlyle's research has been supported by the Medical Education Faculty Fellowship at VCU, and she was an inaugural editor for Pedagogy in Health Promotion: The Scholarship of Teaching and Learning.
Dr. Christopher J. Carpenter is Professor in the Department of Communication at Western Illinois University, where he has been recognized with the Wayne N. Thompson Research Professorship and its associated grant on three separate occasions. Dr. Carpenter is a prolific researcher and author who has published dozens of publications in journals like Health Communication , Communication Studies, and Southern Communication Journal. His work on the Health Belief Model includes "A Meta-analysis of the Effectiveness of Health Belief Model Variables in Predicting Behavior" and the "Health Belief Model" entry in the Encyclopedia of Health Communication. Dr. Carpenter also co-authored the book Critical Questions in Persuasion Research in 2021 with F.J. Boster.
Dr. Fiona Chew is Professor Emerita of Television, Radio and Film in the Newhouse School of Public Communications at Syracuse University. A former film and television producer, her research concerns media messaging, especially in the context of health communication. Dr. Chew has enjoyed a long and influential career -- among other achievements, she was Founding Editor of the Journal of Health and Mass Communication and the keynote speaker at the 2015 International Conference on Environment, Health and Media in Hong Kong. Dr. Chew's research exploring the Health Belief Model includes the co-authored essays, "Methodological Equivalence for Health Belief Modeling in the United States and India" (2006) and "Testing the Influence of the Health Belief Model and a Television Program on Nutrition Behavior" (1998), published in Health Communication. Dr. Chew also served as Faculty Affiliate at Syracuse University's Aging Studies Institute.
Dr. Terry Rentner is Professor in the School of Media & Communication at Bowling Green State University, where she teaches graduate courses in pedagogy, advertising, and public relations. Dr. Rentner's primary research is in the field of health communication, with a particular focus on substance misuse. Her research has appeared in the field's top journals, including the Journal of Health Communication and the International Journal of Communication and Health. Dr. Rentner's most recent research on the Health Belief Model includes "The Health Belief Model and Preventive Measures: A Study of the Ministry of Health Campaign on Coronavirus in Saudi Arabia," published in 2018 with Saud Alsulaiman and "Superman and Wonder Woman: French Champions for HIV/AIDS Prevention or Failed AIDS Campaign?," published with Stephen Croucher in 2016. She is co-editor of the collection Case Studies in Sport Communication: You Make the Call (2019).
Dr. Beth L. Sundstrom is Professor in the Department of Communication at the College of Charleston, where she is also Director of the Women's Health Research Team. Dr. Sundstrom's research focuses on strategic communication in the context of health and medicine and was recognized with a Fulbright fellowship in 2019. She has published three books: Reproductive Justice and Women’s Voices: Health Communication across the Lifespan, Birth Control: What Everyone Needs to Know with Dr. Cara Delay, and Catching Fire: Women's Health Activism in Ireland and the Global Movement for Reproductive Justice with Dr. Delay, as well as a number of articles that consider issues related to reproductive rights, women's health, and health communication. Her contributions to research on the Health Belief Model include the co-authored articles, "Protecting the Next Generation: Elaborating the Health Belief Model to Increase HPV Vaccination Among College-age Women" and "It's My Time: Applying the health belief model to prevent cervical cancer among college-age women." Dr. Sundstrom was recognized by the College of Charleston with the William V. Moore Distinguished Teacher-Scholar Award in 2018.
Dr. Erin Willis is Associate Professor in the Department of Advertising, Public Relations and Media Design at the University of Colorado Boulder. Dr. Willis' scholarship focuses on the relationship between health communication and media and technology studies, with an interest in the ways in which media impacts health messaging. Dr. Willis' research on the Health Belief Model focuses on the ways in which online communities can mediate patients' relationship with their care, as in her piece "Applying the Health Belief Model to Medication Adherence: The Role of Online Health Communities and Peer Reviews," published in Health Communication. Dr. Willis has presented her research at conferences nationally and internationally. Other essays that she has authored have been published in top journals like Health Informatics, Health Promotion and Practice, and Health Psychology.
Key Constructs in the Health Belief Model
The HBM has its theoretical foundation in “phenomenological” approaches to social psychology dominant in health research at the time, which Rosenstock (1974) defines as the philosophical view that “the world of the perceiver” determines their actions and “not the physical environment, except as the physical environment comes to be represented in the mind of the behaving individual.” In more contemporary literature, this perspective is less frequently discussed in the philosophical language of phenomenology. Champion and Skinner (2008) refer to the model as “cognitive” and associate it with value-expectancy theory, a social psychological theory that holds that behavior is determined by the interaction between how individuals value a particular goal and their expectation that taking a certain action will produce the desired outcome. In either case, the social psychology of the HBM holds that individual behaviors cannot be changed directly. In order to change how the public attends to their health, one must change how they perceive the world — that is, one must change their beliefs.
It is the “health beliefs” of the individual, then, that make up the key structures of the HBM. Rosenstock’s early research identifies five main categories of health beliefs relevant to health behaviors. First, there is perceived susceptibility. This describes a person’s belief that they might fall victim to an illness or other health issue — for instance, one’s perception of whether they are likely to catch the flu or are susceptible to cancer. Second is perceived severity, or a person’s perception that, if they were to experience that health problem, there would be a significant negative outcome. In other words, an individual must see contracting the illness, leaving the illness untreated, or failing to continue treatment as a threat. This can include a perception that health-related consequences would be dire or concerns over possible social consequences that could follow indirectly from the health problem.
The third key structure is the perceived benefits of the desired health behavior. It is common for individuals to believe, on the one hand, in the severity of an illness, but, on the other, to also view preventative action or treatment options skeptically. For an individual to participate in a desired health behavior, they must believe that said health behavior will produce its desired outcomes. Non-medical benefits to health behaviors may also be effective and factor into one’s health decisions, such as social or financial benefits (e.g., one may quit smoking for their family or to save money).
Perceived barriers is the fourth key belief and encompasses a person’s perception of the accessibility of the treatment or recommended health behavior, as well as their perception of negative consequences of taking action (e.g., the perception it requires too great a time commitment, or would lead to social stigmatization by exposing a health problem to friends and family). While barriers were less frequently emphasized in early literature, they have proven to be one of the best predictors of health behaviors over time. HBM researchers have also introduced new structures to the model over time, the most influential of which has been self-efficacy, or the belief that one is capable of performing the health behaviors required of them, or doing so well enough to achieve their associated goals.
Alongside these main beliefs, early theorists held that certain contextual cues might catalyze individuals to action, should the appropriate belief structures be in place. These cues have been subject to less empirical research than other HBM constructs. At the same time, scholars who put the HBM into practice are invested in understanding what modes of public persuasion allow for the conversion of health beliefs. This involves considering how media messaging, public health campaigns, and other modes of communication can serve the same function as a cue, in motivating individuals to take health-related actions.
The Health Belief Model in Application
The Health Belief Model was initially conceived with public health interventions in mind. Originally geared toward the study of disease screening and prevention, today the HBM is applied to study a wide variety of health behaviors, from lifestyle health and disease prevention, to symptom management and health-maintenance behaviors in individuals with chronic diseases. Beth Sundstrom’s co-authored study “It’s My Time” is a contemporary example of the HBM applied, as it was originally intended, to the study of preventative health behaviors (Sundstrom et al. 2018). Noting that cervical cancer in the United States “remains a critical public health issue despite medical advances in immunization, screening, and treatment,” especially in the South where screenings are also at their lowest, the authors evaluated the efficacy of Cervical Cancer-Free South Carolina’s (CCFSC) “It’s My Time” health campaign.
The CCFSC campaign was designed around “peer-based interventions,” developed in dialogue with medical professionals, and made use of the HBM in researching and designing these interventions. In the authors’ analysis, they break down the campaign’s initiatives according to the key structures detailed in the previous section. They discuss beliefs regarding the perceived threat or severity of historical cancer, noting students tended to believe that STIs presented a legitimate health concern, but failed to link HPV with cervical cancer, and demonstrated little knowledge of the screening or vaccination processes. Similarly, participants perceived the benefit of HPV screening and vaccination in terms of STI contraction, rather than cancer risk. Barriers the authors consider include time, transportation and cost, which they note are skewed socioeconomically. Finally, they identify the salience of cues to action, including the encouragement of health care providers and the use of social media messaging.
Working from this analysis of the commonly held beliefs of their target audience, the “It’s My Time” campaign designed their messaging and intervention strategies to address the prevalent concerns captured by the model. The HBM informed the campaign’s use of social media and its thematic focus on giving individual’s agency over their time. The authors’ findings stress the efficacy and mutually beneficial nature of the health campaign.
This study provides an excellent example of the overall approach taken by scholars in applying the HBM in public health interventions. The HBM provides a foundation for mapping the perceptions, concerns, and motivations of target audiences, which in turn informs design of campaigns and their use of strategic messaging. This general approach remains more-or-less consistent in scholarship and health campaigns seeking to address why individuals do not seek treatment for medical conditions or fail to self-administer necessary medical care.
While researchers are not always in the position to design health campaigns themselves, the Health Belief Model supplies a framework that health communication scholars can use to examine obstacles to public health and recommend interventions. For example, Erin Willis has conducted research on the role online communities have in facilitating medication adherence in patients with chronic diseases, arguing that online forums show the belief that medication is insufficient to manage pain is the primary obstacle to medication adherence, and that online communities help address this obstacle by allowing individuals to compare the pain they are experiencing. On this basis, she recommends that doctors need to engage in more robust dialogue with their patients about pain and pain management strategies.
Together, these examples illustrate how the HBM has been applied to the analysis of health communication and to the evaluation and guidance of the persuasive interventions used in health campaigns and by healthcare providers. The emphasis on new media found in both of these studies also illustrates the importance that mass media has been afforded in research applying the HBM, as also seen, for example, in Fiona Chew’s (1998) work on television messaging in public health campaigns, and in Jeanine Guidry and colleagues (2019) research on the influence of Instagram posts on public beliefs about the Zika virus. The usefulness of the HBM to applied research and its adaptability to new media technologies help explain why the model continues to provide a valuable resource for health communication scholars decades after its original formulation.
Limitations of the Health Belief Model
While the Health Belief Model has proven to be one of the most enduring and adaptable approaches in health communication, this does not mean it is without its shortcomings. Scholars employing the HBM in the analysis or design of public health initiatives should be cautious of two main problems with the model. First, it has methodological problems that limit its explanatory power. In empirical research, not all of the model’s key structures and beliefs have proven equally predictive of health-related behaviors. Further, the interaction between patients’ different belief structures often remains unclear in applications of the HBM, so that it can be unclear whether one or a combination of influences inspired a related change in health behaviors. Contemporary scholars have sought to address these issues by working to refine the theory, integrating the HBM with other explanatory models, and working with its most useful or reliable structures. While these methodological concerns persist today, this has not stopped the model from being productively applied in a vast amount of research.
The second main limitation to the HBM is much more challenging and pertains to its treatment of context and power. As discussed in the section “Key Constructs in the Health Belief Model,” the phenomenological or cognitive orientation of the HBM holds that how humans perceive reality dictates how they respond to it. While this does not, in principle, exclude issues of social context, in practice contextual dynamics stemming from race, gender, class, and other social hierarchies have frequently been omitted from consideration in HBM analyses or reduced to a question of audience demographics. In reality, racial, social, and economic inequalities are often a primary driver of health behaviors, especially in contributing to the existence of obstacles to care.
In this context, as Emily Tanner-Smith et al. (2010) argue, the treatment of these contextual obstacles as “perceived” can work to put the blame and obligation to change on the individual when they are actually the victims of larger, structural problems in their social contexts that must be addressed. Moreover, in insisting on the universal validity of certain beliefs and attitudes, the HBM often marginalizes or assumes the inferiority of alternative cultural belief systems, especially if those beliefs run contradictory to the findings of Western medicine. Some HBM analyses have even identified cultural beliefs as one of the key obstacles to public health goals (Burgoon and Hall 1994).
The tension between public health and cultural difference is an extremely complex one that is also of paramount importance to health communication scholars, and discussed more deeply in the article Critical Perspectives in Health Communication . For scholars working with the HBM, considering how the model might better account for context, power, and differences in cultural standpoint is a vital area for future research (Davis et al. 2013).
The Health Belief Model Today
Despite the limitations discussed in the previous section, the HBM remains an extremely popular model that continues to inform research on health communication and the strategies of health campaigns both in the United States and internationally. Recent public health challenges have prompted new applications of the model. Most notably, COVID-19 inspired a proliferation of scholarship that employs the HBM to understand the health behaviors of individuals and communities during a global pandemic.
Saud A. Alsulaiman and Terry L. Rentner, for example, studied the impact of the Saudi Arabian Ministry of Health’s “We Can Stop it Campaign” in restoring the ministry’s public credibility and increasing preventative behaviors after the agency’s mishandling of the crisis, while Ronald Carico Jr. et al. (2021) purposed that during the pandemic, community pharmacists ought to employ the HBM in their efforts to motivate individuals to take measures to prevent contracting and spreading the disease.
The role that individual belief plays in motivating how the public responds to health crises was more apparent than ever before during the COVID-19 pandemic. In this context, there is little doubt scholars will continue to find the Health Belief Model an important resource for understanding and influencing health-based decision making. One of the most enduring frameworks in health communication research, the HBM is now poised to retain its relevance in the field as it works to meet the challenges posed by contemporary cultural and political struggles centered on public health.
Sources and Additional Resources
To keep up with research developing and applying the Health Belief Model, consult the journal Health Communication and check out the following resources:
- Alsulaiman, Saud, and Terry Rentner. 2018. “The Health Belief Model and Preventive Measures: A Study of the Ministry of Health Campaign on Coronavirus in Saudi Arabia.” Journal of International Crisis and Risk Communication Research 1 (1): 27–56. https://jicrcr.com/index.php/jicrcr/article/view/1/1.
- Brown, Wendy, Anne Ottney, and Sammie Nguyen. 2011. “Breaking the Barrier: The Health Belief Model and Patient Perceptions Regarding Contraception.” Contraception 83 (5): 453–58. https://www.contraceptionjournal.org/article/S0010-7824(10)00539-1/abstract.
- Burgoon, Michael, and John R. Hall. 1994. “Myths as Health Belief Systems: The Language of Salves, Sorcery, and Science.” Health Communication 6 (2): 97–115. https://www.tandfonline.com/doi/abs/10.1207/s15327027hc0602_2.
- Carico, Ronald “Ron,” Jordan Sheppard, and C. Borden Thomas. 2021. “Community Pharmacists and Communication in the Time of COVID-19: Applying the Health Belief Model.” Research in Social and Administrative Pharmacy 17 (1): 1984–87. https://www.sciencedirect.com/science/article/pii/S155174112030293X?via%3Dihub.
- Champion, Victoria and Celette Sugg Skinner. 2008. The Health Belief Model. In: Glanz et al. Health Behavior and Health Education: Theory, Research, and Practice (4th ed. pp. 45-65).
- Chew, Fiona, Sushma Palmer, and Soohong Kim. 1998. “Testing the Influence of the Health Belief Model and a Television Program on Nutrition Behavior.” Health Communication 10 (3): 227. https://www.tandfonline.com/doi/abs/10.1207/s15327027hc1003_3.
- Croucher, Stephen M, and Terry Retner. 2009. “Superman and Wonder Woman: French Champions for HIV/AIDS Prevention of Failed AIDS Campaign?” Speaker and Gavel 46 (1): 1-15.
- Davis, Jenna L., Kyrel L. Buchanan, and B. Lee Green. 2013. “Racial/Ethnic Differences in Cancer Prevention Beliefs: Applying the Health Belief Model Framework.” American Journal of Health Promotion 27 (6): 384–89. https://journals.sagepub.com/doi/10.4278/ajhp.120113-QUAN-15.
- Janz, Nancy K., and Marshall H. Becker. 1984. “The Health Belief Model: A Decade Later.” Health Education Quarterly 11 (1): 1–47. https://journals.sagepub.com/doi/10.1177/109019818401100101.
- Jones, Christina L., Jakob D. Jensen, Courtney L. Scherr, Natasha R. Brown, Katherine Christy and Geremy Weaver. 2015. “The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation,” Health Communication, 30(6): 566-576.
- Jose, Regi, Meghana Narendran, Anil Bindu, Nazeema Beevi, Manju L, and P.V. Benny. 2021. “Public Perception and Preparedness for the Pandemic COVID 19: A Health Belief Model Approach.” Clinical Epidemiology and Global Health 9 (January): 41–46. https://www.ceghonline.com/article/S2213-3984(20)30166-4/fulltext.
- Rosenstock, Irwin M. 1974. “Historical Origins of the Health Belief Model.” Health Education Monographs 2 (4): 328–35. https://journals.sagepub.com/doi/10.1177/109019817400200403.
- Shafer, Autumn, Kelly Kaufhold, and Yunjuan Luo. 2018. “Applying the Health Belief Model and an Integrated Behavioral Model to Promote Breast Tissue Donation Among Asian Americans.” Health Communication, 33 (7): 833–41.
- Tanner-smith, Emily and Tony N. Brown. 2010. “Evaluating the health belief model: A critical review of studies predicting mammographic and pap screening.” Social Theory & Health, 8(1), 95-125. https://link.springer.com/article/10.1057/sth.2009.23.
- Willis, Erin. 2018. “Applying the Health Belief Model to Medication Adherence: The Role of Online Health Communities and Peer Reviews.” Journal of Health Communication 23 (8): 743–50. https://www.tandfonline.com/doi/full/10.1080/10810730.2018.1523260.
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