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Health belief model: need for more utilization in alcohol and drug education.

The health belief model (HBM) is one of the first theories developed exclusively for health-related behaviors (Sharma & Romas, 2012). Although labeled a "model," the HBM meets all the criteria for a behavioral theory. The HBM originated in the 1950s and has been thoroughly tested in a variety of situations since that time. Today it is one of the most popular models, as it provides specific guidance at the micro level for planning the "how to" part of interventions. Based on experimentation over the years, the HBM has expanded and borrowed from other theories to strengthen its predictive and explanatory potential.

The HBM has six constructs, the first of which is perceived susceptibility. This refers to the subjective belief that a person has with respect to acquiring a disease or reaching a harmful state as a result of indulging in a particular behavior. Individuals vary considerably in their perception of susceptibility to any given illness or harmful condition. On one extreme are individuals who completely deny any possibility of their acquiring the disease. In the middle are people who may admit to the possibility of acquiring the disease but believe it is not likely to happen to them. At the other extreme are people who are so fearful of acquiring the disease that they believe they will in all probability acquire it. The more susceptible a person feels, the greater the likelihood of his or her taking preventive measures.

The second construct of HBM is perceived severity, which refers to a person's subjective belief in the extent of harm that can result from the disease or harmful state resulting in a particular behavior. This perception also varies from person to person. One person might perceive the disease from a purely medical perspective and thus be concerned with signs, symptoms, any limitations arising out of the condition, the temporary or permanent nature of the condition, its potential for causing death, and so on. Another individual might look at the disease from a broader perspective, such as the adverse effects it might have on his or her family, job, and relationships. The constructs of perceived severity and perceived susceptibility are often grouped together and called perceived threat.

The third construct of the HBM is perceived benefits, which refers to belief in the advantages of the methods suggested for reducing the risk or seriousness of the disease or harmful state resulting from a particular behavior. The relative effectiveness of known available alternatives plays a role in shaping actions. An alternative is likely to be seen as beneficial if it reduces the perceived susceptibility or perceived severity of the disease.

The fourth construct, which goes hand in hand with the construct of perceived benefits, is perceived barriers. Perceived barriers refer to beliefs concerning the actual and imagined costs of following the new behavior. An individual may believe that a new action is effective in reducing perceived susceptibility or perceived severity of the disease but may consider the action to be expensive, inconvenient, unpleasant, painful, or upsetting.

The fifth construct in the HBM is cues to action, which are the precipitating forces that make a person feel the need to take action. These cues may be internal (e.g., perception of a bodily state) or external (e.g., interpersonal interactions, media communication, or receiving a postcard from the doctor for a follow-up examination).

The final construct is self-efficacy which was added to the model in the 1980s (Rosenstock, Strecher, & Becker 1988). Self-efficacy is the confidence that a person has in his or her ability to pursue a behavior. It is behavior specific and is in the present. It is not about the past or future.

Health belief model has been utilized in alcohol and drug education to some extent. Von and colleagues (2004) used this model to predict alcohol, smoking, and other behaviors in college students. Welch (2000) applied HBM for studying psychosocial factors for drug use among HIV infected individuals. Minugh, Rice and Young (1998) used HBM to study the relationship between health beliefs, health practices, and alcohol consumption among men and women in a sample drawn from the National Health Interview Survey. Hahn (1993) used HBM to examine differences between parent alcohol and other drug users and parent nonusers as related to health beliefs about their involvement in alcohol and other drug prevention with their preschoolers. Hingson and colleagues (1990) used HBM to study beliefs about AIDS, use of alcohol and drugs and unprotected sex in adolescents.

Most of the studies done in alcohol and drug education with regard to HBM are health behavior studies or survey research. Not many interventions have been done that utilize HBM to modify these behaviors. Future researchers could utilize HBM for this purpose. HBM, especially after being bolstered with the construct of self-efficacy in the 1980s, is a fairly robust model and can be effective for alcohol and drug education interventions. HBM also has some limitations. Harrison, Mullen, and Green (1992) conducted a meta-analysis of the relationships among four HBM dimensions (perceived susceptibility, perceived severity, perceived benefits, and perceived costs) and health behaviors in 16 studies. They computed mean effect sizes for all studies and found weak effect sizes and lack of homogeneity in a majority of the studies. They concluded that the model lacked consistent predictive power mainly because it focuses on a limited number of factors. Cultural factors, socioeconomic status, and previous experiences also shape health behaviors, and those factors are not accounted for in the model. A study by Mullen, Hersey, and Iverson (1987) found less predictive power for the HBM when compared with the theory of reasoned action, the theory of planned behavior, and the PRECEDE-PROCEED model. However, even with the limitations HBM is a useful behavioral theory and must be used particularly for designing interventions for alcohol and drug education.


Hahn, E. J. (1993). Parental alcohol and other drug (AOD) use and health beliefs about parent involvement in AOD prevention. Issues in Mental Health Nursing, 14(3), 237-247.

Harrison, J. A., Mullen, P. D., & Green, L. W. (1992). A meta-analysis of studies of the health belief model with adults. Health Education Research, 7(1), 107-116.

Hingson, R. W., Strunin, L., Berlin, B. M., & Heeren, T. (1990). Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. American Journal of Public Health, 80(3), 295-299.

Minugh, P. A., Rice, C., & Young, L. (1998). Gender, health beliefs, health behaviors, and alcohol consumption. The American Journal of Drug and Alcohol Abuse, 24(3), 483-497.

Mullen, P. D., Hersey, J. C., & Iverson, D. C. (1987). Health behavior models compared. Social Science and Medicine, 24, 973-981.

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15, 175-183.

Sharma, M. & Romas, J. A. (2012). Theoretical foundations of health education and health promotion (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Von, A. D, Ebert, S., Ngamvitroj, A., Park, N., & Kang, D. H. (2004). Predictors of health behaviours in college students. Journal of Advanced Nursing, 48(5), 463-474.

Welch, K. J. (2000). Correlates of alcohol and/or drug use among HIV-infected individuals. AIDS Patient Care and STDs, 14(6), 317-323.

Manoj Sharma, MBBS, CHES, Ph.D.

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Author:Sharma, Manoj
Publication:Journal of Alcohol & Drug Education
Article Type:Editorial
Geographic Code:1USA
Date:Apr 1, 2011
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