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How the Health Belief Model Influences Your Behaviors

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• Effectiveness

The Takeaway

Frequently asked questions, what is the health belief model.

Scientists use the health belief model (HBM) to try to predict health behaviors. Originally developed in the 1950s and proposed by social psychologists Godfrey Hochbaum, Irwin Rosenstock, and Rosenstock and Kirscht , the health belief model is based on the theory that the willingness to change health behaviors primarily comes from health perceptions.

According to the health belief model, your beliefs about health and health conditions play a role in determining your health-related behaviors. Key factors that affect your approach to health include:

• Barriers you think might be standing in your way
• Exposure to information that prompts you to take action
• Perceived benefit of engaging in healthy behaviors
• Perceived susceptibility to illness
• Perceived consequences of sickness
• Confidence in your ability to succeed

Health experts often look for ways that health belief models affect people's actions, particularly as they relate to individual and public health.

This article discusses how the health belief model works, the different components of the model, and how this approach can be used to address health-related behaviors.

Components of the Health Belief Model

There are six main components of the health belief model. Four of these constructs were main tenets of the theory when it was first developed. Two were added in response to research on the model related to addiction.

Perceived Severity

The probability that a person will change their health behaviors to avoid a consequence depends on how serious they believe the consequences will be. For example:

• If you are young and in love, you are unlikely to avoid kissing your sweetheart on the mouth just because they have the sniffles and you might get their cold. On the other hand, you probably would stop kissing if it might give you a more serious illness.
• Similarly, people are less likely to consider condoms when they think STDs are a minor inconvenience. That's why receptiveness to messages about safe sex increased during the AIDS epidemic. The perceived severity increased enormously. 

The severity of an illness can have a major impact on health outcomes. However, a number of studies have shown that perceived risk of severity is actually the least powerful predictor of whether or not people will engage in preventive health behaviors.

Perceived Susceptibility

People will not change their health behaviors unless they believe that they are at risk. For example:

• Individuals who do not think they will get the flu are less likely to get a yearly flu shot.
• People who think they are unlikely to get skin cancer are less likely to wear sunscreen or limit sun exposure.
• Those who do not think that they are at risk of acquiring HIV from unprotected intercourse are less likely to use a condom.
• Young people who don't think they're at risk of lung cancer are less likely to stop smoking.

Research suggests that perceived susceptibility to illness is an important predictor of preventive health behaviors.  

Perceived Benefits

It's difficult to convince people to change a behavior if there isn't something in it for them. People don't want to give up something they enjoy if they don't also get something in return. For example:

• A person probably won't stop smoking if they don't think that doing so will improve their life in some way.
• A couple might not choose to practice safe sex if they don't see how it could make their sex life better. 
• People might not get vaccinated if they do not think there is an individual benefit for them.

These perceived benefits are often linked to other factors, including the perceived effectiveness of a behavior. If you believe that getting regular exercise and eating a healthy diet can prevent heart disease, that belief increases the perceived benefits of those behaviors.

Perceived Barriers

One of the major reasons people don't change their health behaviors is that they think doing so is going to be hard. Changing health behaviors can require effort, money, and time. Commonly perceived barriers include:

• Amount of effort needed
• Inconvenience
• Social consequences

Sometimes it's not just a matter of physical difficulty, but social difficulty as well. For example, If everyone from your office goes out drinking on Fridays, it may be very difficult to cut down on your alcohol intake. If you think that condoms are a sign of distrust in a relationship, you may be hesitant to bring them up. 

Perceived barriers to healthy behaviors have been shown to be the single most powerful predictor of whether people are willing to engage in healthy behaviors.  

When promoting health-related behaviors such as vaccinations or STD prevention, finding ways to help people overcome perceived barriers is important. Disease prevention programs can often do this by increasing accessibility, reducing costs, or promoting self-efficacy beliefs.

Cues to Action

One of the best things about the Health Belief Model is how realistically it frames people's behaviors. It recognizes the fact that sometimes wanting to change a health behavior isn't enough to actually make someone do it.

Because of this, it includes two more elements that are necessary to get an individual to make the leap. These two elements are cues to action and self-efficacy.

Cues to action are external events that prompt a desire to make a health change. They can be anything from a blood pressure van being present at a health fair, to seeing a condom poster on a train, to having a relative die of cancer. A cue to action is something that helps move someone from wanting to make a health change to actually making the change.

Self-Efficacy

Self-efficacy wasn't added to the model until 1988. Self-efficacy looks at a person's belief in their ability to make a health-related change. It may seem trivial, but faith in your ability to do something has an enormous impact on your actual ability to do it.

Finding ways to improve individual self-efficacy can have a positive impact on health-related behaviors. For example, one study found that women who had a greater sense of self-efficacy toward breastfeeding were more likely to nurse their infants longer. The researchers concluded that teaching mothers to be more confident about breastfeeding would improve infant nutrition.

Thinking that you will fail will almost make certain that you do. Self-efficacy has been found to be one of the most important factors in an individual's ability to successfully negotiate condom use.

There are six components of the Health Belief Model. They are perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy.

Examples and Uses of the Health Belief Model

One important aspect of public health is the design of programs that encourage people to engage in healthy behaviors, so understanding how the health belief model can apply to different situations can be useful.

For example, experts may be interested in understanding public attitudes about cancer screenings. Looking at factors such as perceptions of cancer risk, the benefits of being screened for cancer, and the barriers to being screened can help healthcare professionals look for ways to encourage people to get screened.

The health belief model may also be used for public health programs. Schools, for example, may rely on educational programs to help children understand challenges regarding health, substance use, physical activity, nutrition, and personal safety. Such programs are often based on the health belief model and work to educate, offer skills training, reduce barriers, and boost self-efficacy.

Healthcare professionals and public health experts apply the health belief model to create programs and interventions to help prevent health problems, encourage treatment behaviors , and support behavior change.

How Effective Is the Health Belief Model?

The health belief model has been used for decades to help produce behavior change interventions. Research suggests that the health belief model can help professionals develop strategies that promote healthy behaviors and improve the prevention and treatment of health conditions. 

A study published in Health Psychology Review found that, in studies looking at the health belief model, 78% reported significant improvement in behavior adherence. Of the studies they looked at, 39% reported moderate to large effects related to health interventions.

Criticisms of the Health Belief Model

Critics of the health belief model assert that it fails to address:

• How habits can shape decisions
• The fact that people often engage in actions for reasons other than health, such as social acceptance
• Economic and environmental factors, such as living in a food desert or lacking resources to afford fresh fruits and vegetables
• Individual beliefs, attitudes, and other characteristics
• How to change health behaviors rather than merely describe them

The health belief model can help health educators design interventions to improve individual and public health. By understanding the factors that influence health-related choices, healthcare professionals can tackle ways to reduce barriers, improve knowledge, and help motivate action .

The Health Belief Model was created by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal during the 1950s. It was developed for the U.S. Public Health Services to understand why people fail to engage in healthy behaviors.

One of the main benefits of the Health Belief Model is that it simplifies health-related constructs so they can be more readily tested and implemented in public health settings. Because it emphasizes some of the prerequisites for health behaviors, it can be helpful for addressing the things that need to happen before a person can successfully implement a behavior change.

The Health Promotion Model is a multidimensional approach that takes into account how a person's interaction with their environment affects their health choices. It is similar to the Health Belief Model in some ways, but where the HBM is focused on being health-protective, the Health Promotion Model focuses more on helping people improve their well-being and achieve self-actualization .

Ghorbani-Dehbalaei M, Loripoor M, Nasirzadeh M. The role of health beliefs and health literacy in women’s health promoting behaviours based on the health belief model: a descriptive study .  BMC Women’s Health . 2021;21(1):421.

Jones CL, Jensen JD, Scherr CL, Brown NR, Christy K, Weaver J. The Health Belief Model as an explanatory framework in communication research: Exploring parallel, serial, and moderated mediation .  Health Commun . 2015;30(6):566-576. doi:10.1080/10410236.2013.873363

Loke AY, Chan LK. Maternal breastfeeding self-efficacy and the breastfeeding behaviors of newborns in the practice of exclusive breastfeeding .  J Obstet Gynecol Neonatal Nurs . 2013;42(6):672-684. doi:10.1111/1552-6909.12250

Montanaro EA, Bryan AD. Comparing theory-based condom interventions: Health belief model versus theory of planned behavior . Health Psychol . 2014;33(10):1251-60. doi:10.1037/a0033969

Baghianimoghadam MH, Shogafard G, Sanati HR, Baghianimoghadam B, Mazloomy SS, Askarshahi M. Application of the Health Belief Model in promotion of self-care in heart failure patients . Acta Med Iran . 2013;51(1):52-8.

Jones CJ, Smith H, Llewellyn C. Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review . Health Psychol Rev . 2014;8(3):253-69. doi:10.1080/17437199.2013.802623

Carpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior . Health Commun . 2010;25(8):661-9. doi:10.1080/10410236.2010.521906

Orji R, Vassileva J, Mandryk R. Towards an effective health interventions design: An extension of the health belief model .  Online J Public Health Inform . 2012;4(3):ojphi.v4i3.4321. doi:10.5210/ojphi.v4i3.4321

Galloway RD. Health promotion: causes, beliefs and measurements .  Clin Med Res . 2003;1(3):249-258. doi:10.3121/cmr.1.3.249

By Elizabeth Boskey, PhD Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. 

What Is the Health Belief Model? An Updated Look

Despite this fact, participation in screening tends to be low. In Australia, only 40% of adults opted for screening for bowel cancer in 2021 — 3% lower than the previous year (Australian Institute of Health and Welfare, 2023).

Why do people decide not to participate in a low-risk activity like screening? Or visit the dentist regularly, or quit smoking? Why do we choose to ignore these necessary health steps?

Why and how people view the risks of disease, and the subsequent likelihood of people adjusting their behaviors, can be better understood with the health belief model.

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This Article Contains

A brief history of the health belief model, primary components of the health belief model theory, 3+ health belief model application examples, updates and modifications to the hbm, criticisms of the hbm, 6 worksheets and interventions, a take-home message.

Researchers knew that socioeconomic, sociocultural, and demographic factors, such as age, gender, ethnicity, and race, influenced the likelihood that people could afford health care and would seek it out (Abraham & Sheeran, 2015). However, what researchers observed in the 1950s surprised them.

In the 1950s, screening for tuberculosis was made easier and more accessible with mobile X-ray vans, removing the need for patients to make costly and time-consuming trips to hospitals and clinics. What social psychologists Hochbaum, Rosenstock, and Kegels observed was surprising: Despite the increased accessibility and convenience, there was meager participation (Daniati et al., 2021; Skinner et al., 2015). Why would this be?

These researchers posited that patients’ beliefs, attitudes, and understanding of the illness and health care greatly influenced the likelihood that they would seek preventive treatments and screening (Janz & Becker, 1984). This hypothesis resulted in the health belief model (HBM).

The HBM consisted of the following five concepts:

• Perceived susceptibility describes the individual’s belief about the likelihood of getting a particular health condition.
• Perceived severity refers to the individual’s belief about the seriousness of the health condition and its consequences.
• Perceived benefits describe the belief in the effectiveness of taking action to reduce risk or seriousness of the health condition.
• Perceived barriers refer to the perceived obstacles or costs associated with taking action to reduce the risk or seriousness of a health condition.
• Cues to action are triggers that prompt individuals to take action, such as symptoms, media campaigns, or recommendations from health care providers.

The health belief model was later modified to include additional factors. These are self-efficacy, our belief in our ability to take action, and the importance of socio-demographic factors.

Here is a short video that uses a simple example to explain the HBM.

Although the original use case of the HBM was to explain low participation in preventive screening programs for diseases, it has since been applied to other scenarios. These include smoking cessation treatments, vaccination programs, and treatment adherence.

These components explain how individuals gauge the threat of behaviors and illnesses and interpret and value the efficacy of treatment, ultimately shaping their decision to adopt health-promoting behaviors (Abraham & Sheeran, 2015).

We will go through each component in more detail below.

1. Perceived susceptibility

Perceived susceptibility refers to how an individual’s belief in their vulnerability to a specific disease can lead to preventive actions and behaviors. For example, people who believe they are at severe risk of contracting the flu are more likely to opt for a flu vaccine.

2. Perceived severity

People are more likely to engage in behaviors to mitigate health issues when they perceive a health issue as serious and think that it might impact their lives. This is known as perceived severity . For example, knowing the risks of smoking-related diseases can encourage quitting.

3. Perceived benefits

Perceived benefits describe how individuals are also more likely to engage in certain behaviors if they positively perceive the benefits of those behaviors. For example, people who perceive the benefits of regular exercise positively are more likely to exercise than people who undervalue or do not recognize the benefits of exercise.

4. Perceived barriers

Perceived barriers refer to the severity and difficulty of obstacles/barriers that can significantly impact whether individuals are likely to adopt certain behaviors. If people have to overcome many obstacles to achieve a particular goal, they are less likely to adopt and maintain the behavior.

These obstacles can be practical, psychological, or social and can include cost, inconvenience, fear, or a lack of social support. More examples of barriers include the cost of a gym membership, clinic location, the psychological effort to complete a task, or the time needed to exercise.

5. Cues to action

The fifth component, cues to action , prompts individuals to take action regarding their health. These cues can be internal, such as personal experiences, or external, such as advice from health care providers.

These cues influence health-related decision-making and actions by closing the gap between awareness of health risks and the initiation of appropriate health behaviors. For example, people know when to seek out a health care professional if they can identify symptoms of certain illnesses.

6. Self-efficacy

Self-efficacy is the sixth component added to later adaptations of the health belief model. Self-efficacy is our belief in our ability to perform healthy behaviors successfully. Higher levels of self-efficacy are associated with greater motivation and persistence in adopting and maintaining health-promoting behaviors.

Examples of self-efficacy are trusting in our ability to succeed and recognizing that we have the skill set and knowledge to overcome challenges.

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The health belief model can be applied to several health-related contexts to explain behavior and participation (Abraham & Sheeran, 2015).

Some examples include:

• Programs that tackle preventive behaviors, such as screening, risk behaviors, vaccinations, and contraceptive behaviors
• Adherence programs for the treatment of various illnesses
• Clinic visits

We will briefly look at a few of these applications in more detail.

Smoking cessation programs

To measure knowledge and perception of health behaviors related to smoking cessation, health educators and practitioners used questionnaires measuring various components of the HBM (Renuka & Pushpanjali, 2014). The aim of the study was to determine whether attitudes, behaviors, and knowledge of tobacco use could change through health care education.

This study was specifically conducted in dental care settings due to the relationship between tobacco use and dental health. Tobacco use is correlated with various dental illnesses and conditions, including dental cancer and cleft lip and palate (Renuka & Pushpanjali, 2014).

Results of the study showed that health behavior and knowledge around tobacco and smoking behaviors improved overall. Dental behavior also significantly improved, but only for younger participants, participants who smoked tobacco products (as opposed to vaping), and individuals who already visited the dentist at least once per year. So improvement in these three domains reduces the risk of oral diseases associated with smoking.

Cancer screening campaigns

Research has shown that incorporating HBM components into cancer screening campaigns is compelling and informative. For example, Luquis and Kensinger (2019) found that two components of the health belief model — perceived susceptibility and perceived seriousness — significantly predicted whether younger adults were likely to regularly screen for various cancers.

Vaccination campaigns

Previous studies have found a significant correlation between several components of the HBM and vaccination hesitancy. A systematic review of 16 studies with over 30,000 participants found that vaccine hesitancy was linked to perceived barriers in a positive way (Limbu et al., 2022).

On the other hand, vaccine hesitancy was linked to perceived benefits, perceived susceptibility, cues to action, perceived severity, and self-efficacy in a negative way (Limbu et al., 2022). These results confirm previous findings in the literature (e.g., Mercadante & Law, 2021).

With this insight, health authorities and organizations can use the HBM to encourage vaccination uptake by addressing:

• Individuals’ perceptions of susceptibility to vaccine-preventable diseases
• The severity of those diseases
• The benefits of vaccination for personal and community health
• Strategies to overcome vaccine-related barriers, such as vaccine hesitancy and misinformation

Other areas where the health belief model has been successfully applied include:

• Diabetes (Gillibrand & Stevenson, 2006; Sharifirad et al., 2006)
• Exercise (King et al., 2013)

Interestingly, applying the HBM outside the medical domain has had less success. For example, research suggests that the HBM has limited predictive value in explaining and improving seat belt usage (Şimşekoğlu & Lajunen, 2008; Tavafian et al., 2011).

These examples illustrate how the health belief model can inform the development and implementation of health promotion initiatives across various health issues.

Some of these updates and modifications include the following.

Inclusion of additional constructs

One significant modification involves the inclusion of additional constructs beyond the original components of the HBM. For example, self-efficacy, which refers to an individual’s belief in their ability to perform a specific behavior successfully, was incorporated into the model following research by King (1982, as cited in Abraham & Sheeran, 2015).

King argued that self-efficacy was an excellent predictor of patients attending hypertension screening (King, 1982, as cited in Abraham & Sheeran, 2015). Over time, this concept merged with research into locus of control and perceived control and became known as self-efficacy.

Integration with social cognitive theory

The efficacy of the health belief model is improved when used alongside other theories. One such example is the social cognitive theory (SCT).

Social cognitive theory emphasizes the role of observational learning, social influence, and self-regulation in shaping health behaviors (Abraham & Sheeran, 2015).

Integrating SCT with the HBM provides a more comprehensive understanding of how individuals’ beliefs, social environment, and self-efficacy influence health-related decisions and actions.

Incorporation of technology

With the advancement of technology, researchers and practitioners have explored the use of digital platforms, mobile apps, and online interventions to apply the principles of the health belief model in promoting health behaviors.

These technology-based interventions leverage interactive features, personalized feedback, and social support to enhance individuals’ motivation, self-efficacy, and engagement in health-promoting activities (Kim & Park, 2012).

Additionally, when paired with the technology acceptance model to measure the perceived usefulness of the internet for health information and attitudes toward internet use for health purposes, the positive effects of the HBM are amplified and the model is strengthened (Ahadzadeh et al., 2015).

Overall, the updates and modifications to the health belief model reflect efforts to enhance its theoretical robustness, practical utility, and cultural relevance in promoting health behavior change across diverse populations and settings.

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Initial criticism of the model focused on the poorly defined constructs underpinning the HBM and its poor predictive statistical power (Armitage & Conner, 2000).

Although changes have been made, not all researchers and authors agree about the improvements and modifications made to the health belief model.

Some of the controversies associated with the improvements and modifications include theoretical disagreements about the underlying constructs that compose the model. Also, there is substantial overlap between models explaining health behavior, such as the health belief model and another theory, protection motivation theory (Abraham & Sheeran, 2015).

Other criticisms include the fact that the HBM largely ignores structural barriers. For example, changing attitudes and beliefs about health care does little to combat the cost of health care treatment (Wong et al., 2020).

Despite these controversies and challenges, the health belief model remains a valuable framework for understanding and promoting health behavior change.

Researchers continue to explore its applications, refine its constructs, and evaluate its effectiveness in diverse contexts. The debates surrounding the HBM contribute to ongoing discussions within health psychology and public health, fostering critical reflection and innovation in theory and practice.

Health belief model scale

Various HBM scales exist, and the difference between them is their application, because the scales measure beliefs and attitudes around a disease, behavior, treatment, or intervention of interest.

For practitioners interested in using questions from a health belief model scale to measure clients’ attitudes toward a particular treatment or behavior, they will need to adapt existing tools and interventions to incorporate the model’s principles.

• To measure attitudes toward exercise, readers can refer to Wu et al. (2020). They developed an 18-item scale with good psychometric properties. For questions around other behaviors, such as lifestyle or prevention, readers can refer to Şimşekoğlu and Lajunen (2008).
• To measure HBM constructs around self-examination, see Abraham and Sheeran (2015).
• For readers who are interested in focusing on only one component of the HBM and want to know how to adapt or target those aspects, see Orji et al. (2012). They have a useful table detailing various interventions that can be applied for each submeasure.

Health belief assessment worksheet

The Technical Assistance Network for Children’s Behavioral Health released an extensive toolkit that measures various beliefs around healthcare (Concha et al., 2014).

This 33-item questionnaire was designed to measure questions around health care relating to community, spiritual care, family, knowledge of illness, perceptions of health care practitioners, service delivery, and community.

It is quite extensive and can guide practitioners in uncovering any beliefs or attitudes that might be preventing a client from seeking or persisting in their health care journey. The worksheet is available at the University of Florida website .

SMART goals

To help clients meet their goals, practitioners can guide clients through a goal-setting exercise based on the principles of the health belief model. For example, encourage them to set specific, measurable, achievable, relevant, and time-bound (SMART) goals related to improving their health behaviors.

In this exercise, practitioners can help clients identify strategies to address perceived barriers and enhance the perceived benefits of adopting healthier habits .

Here are two worksheets to help you.

• The first worksheet helps you and your client identify the important questions needed to achieve their goals.
• The second worksheet is a condensed version of the first and can be used to track multiple goals. The second worksheet is useful once your client understands the SMART process.

Decisional balance worksheet

When helping clients make a decision about their health behaviors, practitioners can use a decisional balance worksheet to help clients weigh the pros and cons.

Ask clients to list the advantages and disadvantages of adopting healthier behaviors, considering factors such as perceived benefits, perceived barriers, and the potential outcomes of their actions. This list will help clients gain insight into their own beliefs, make informed decisions, and prioritize goals.

In this decision-making worksheet , clients are asked to list the different options available to them and list the pros and cons associated with each.

If you want to help your client evaluate their past decisions so that they can identify which decisions were good and bad, then the Behavior Self-Evaluation worksheet will help you. Clients are asked to identify previous decisions, evaluate the outcome, and decide whether they would change their decision and why.

By integrating these worksheets and interventions into coaching or counseling sessions, practitioners can effectively apply the principles of the health belief model to support clients in achieving their health and wellness goals. Practitioners will need to adapt existing tools, questions, and worksheets to individual clients to ensure its appropriateness.

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The health belief model is a useful framework for making sense of why we choose whether to participate in certain health behaviors.

With this framework, practitioners can isolate and explore different aspects of clients’ decision-making processes, help clients gain insight into their behavior, and identify the challenges they experience with implementing positive change.

Although the health belief model is not applicable to every situation, it can still be leveraged to gain insight. Remember that change will not be immediate. Help manage your clients’ expectations; small changes are not always visible, but they add up over time.

Before you go, make sure to read these posts about changing behavior in your clients.

• What Is Behavior Change in Psychology? 5 Models and Theories
• How to Change Self-Limiting Beliefs According to Psychology

Let us know in the comments if this post helped you gain insight into your own behavior or that of your clients.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

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• Wu, S., Feng, X., & Sun, X. (2020). Development and evaluation of the health belief model scale for exercise. International Journal of Nursing Sciences , 7 , S23–S30.

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Health Belief Model: Description and Concepts Essay

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Health Belief Model (HBM) is broadly applied in health promotion because it effectively influences people’s behavior by revealing their actions’ value. It has been developed in the 1950s by Hockbaum, Kegeles, Leventhal, and Rosenstock to explain the health services’ operation based on the goal-oriented decision-making model (McKenzie et al., 2013). HBM is crucial for public health because an individual’s actions towards healthy or preventative practices depend on modifying factors such as demographic and sociopsychological variables, mass media, and society’s awareness (McKenzie et al., 2013).

The concept is based on a person’s sufficient motivation to affect an issue, the existence of a threat, and the realization that the benefits are worth the cost (McKenzie et al., 2013). HBM is beneficial for detailed explaining individual behavior in detail based on psychological properties and structures, however, it overlooks macro-structures that constrain personal thoughts and motivations (Kim & Kim, 2020). In theory, the necessary behavior will be achieved when those three facts are addressed simultaneously.

The brightest example of influencing decision-making in public health is the recent COVID-19 vaccination promotion. Mercadante and Law (2020) state that “testing HBM with the willingness to receive COVID-19 vaccine displayed that perceived benefits were significantly related to a “definite intention.” Besides, the demand in taking preventative action is broadly promoted in social media. Numerous campaigns describe the individual threats of avoiding immunization, and public health representatives encourage people worldwide to participate in eliminating the pandemic (Mercadante & Law, 2020). Kim and Kim (2020) claim that “when people are confident that a protective behavior is effective, and perceive low costs to adopting the precautionary behavior, they are more willing to adopt the recommended behavior.” The conceptual model below is based on the U.S. citizens’ behavioral patterns towards receiving the COVID-19 vaccine.

Perceived susceptibility and severity of an issue in HBM is defined as a factor that forces a person to seek preventative or helpful actions to take. In relation to getting the COVID-19 vaccine, all the citizens are aware of the pandemic, and its consequences affected everyone’s life. However, the biases about immunizations and the virus’s novelty decrease the willingness to prevent or eliminate the health issue (Kim & Kim, 2020). Consequently, the primary construct is the motivation sufficiency which must be increased by showing a person the social authorities’ example and displaying becoming vaccinated as proper civic behavior.

Identifying the possible threat is one of the concepts applied in HBM to move a person towards performing specific actions. Indeed, describing danger can be enforced by revealing the statistics about COVID-19 death cases and publishing information about the disease’s challenging course and consequences in the news. In addition to the motivation and understanding the danger of improper behavior, a person needs to realize that the benefits are worth the cost to take action. Thus, the vaccination’s promotion must address the low cost of the shot, social and workplace encouragement to cease the infection spread (Scherr et al., 2017). c

Kim, S., & Kim, S. (2020). Analysis of the impact of health beliefs and resource factors on preventive behaviors against the COVID-19 Pandemic . International Journal of Environmental Research and Public Health, 17 (22), 8666. Web.

McKenzie, J. F., Neiger, B. F., & Thackeray, R. (2013). Planning, implementing, and evaluating health promotion programs: A primer (6th ed.). Pearson.

Mercadante, A. R., & Law, A. V. (2020). Will they, or won’t they? Examining patients’ vaccine intention for flu and COVID-19 using the Health Belief Model . R esearch in Social and Administrative Pharmacy. Web.

Scherr, C. L., Jensen, J. D., & Christy, K. (2017). Dispositional pandemic worry and the health belief model: promoting vaccination during pandemic events . Journal of Public Health, 39 (4), 242–250. Web.

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• Published: 18 March 2020

A philosophy of health: life as reality, health as a universal value

• Julian M. Saad   ORCID: orcid.org/0000-0002-9323-1021 1 &
• James O. Prochaska 1  

Palgrave Communications volume  6 , Article number:  45 ( 2020 ) Cite this article

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Emphases on biomarkers (e.g. when making diagnoses) and pharmaceutical/drug methods (e.g. when researching/disseminating population level interventions) in primary care evidence philosophies of health (and healthcare) that reduce health to the biological level. However, with chronic diseases being responsible for the majority of all cause deaths and being strongly linked to health behavior and lifestyle; predominantly biological views are becoming increasingly insufficient when discussing this health crisis. A philosophy that integrates biological, behavioral, and social determinants of health could benefit multidisciplinary discussions of healthy publics. This manuscript introduces a Philosophy of Health by presenting its first five principles of health. The philosophy creates parallels among biological immunity, health behavior change, social change by proposing that two general functions— precision and variation —impact population health at biological, behavioral, and social levels. This higher-level of abstraction is used to conclude that integrating functions, rather than separated (biological) structures drive healthy publics. A Philosophy of Health provides a framework that can integrate existing theories, models, concepts, and constructs.

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A philosophy of health.

What is health? Is it a state of the body or the mind? Is health primarily a natural, biological state or a holistic, value-laden state? Naturalistic and holistic philosophies of health have provided very important, but very different, perspectives of population health. Naturalistic views (e.g. as seen in Boorse, 1997 ) provide insight into physical, natural, biological, or physiological processes that are tangible (in the material sense), observable, and measurable with modern technology. Complementarily, holistic views contend that value-laden phenomena (e.g. vital goals, meaning, and purpose) play a central role in population health (Nordenfeldt, 2007 ).

A dialog, or as we see it, an important dialectic among naturalistic and holistic perspectives plays out between the Biostatistical Theory of Health (BST) and the Holistic Theory of Health (HTH). The BST posits that a person is healthy if and only if, all natural organs function normally given a statistically normal environment (Boorse, 1997 ). The HTH posits that a person is healthy if and only if (given standard circumstances) he/she has the ability to attain their vital goals (Nordenfeldt, 2007 ).

In addition to defining health, each philosophy defines disease. The BST poses that disease is the internal state of impairment to the normal functioning of organs (Boorse, 1997 ). In the HTH, an organ dysfunction is a disease if and only if the organ’s process reduces the person’s ability to pursue vital goals or life-purpose (Nordenfelt, 2007 ). In BST health is the absence of disease; and in HTH, health is not the absence of biological disease, but is the whole person’s ability to function in relation to vital goals.

Both naturalistic and holistic perspectives guide important observations of health and disease. When one considers health through the BST one pays close attention to the functions of the internal, biological functioning of the human being. When one considers health through the HTH, one pays close attention to the functioning of an individual, in relation to their external, societal/cultural functions. Is there a hybrid model that accounts for both internal and external functioning?

Wakefield’s ( 2014 ) harmful dysfunction analysis (HDA) creates a hybrid model that integrates natural- and value-laden phenomena when conceptualizing disease. HDA asserts that a person suffers from a disorder/disease if (1) the condition causes harm (as judged by the standards of the person’s culture); or if (2) the person’s internal, natural processes cannot perform normal functioning (as judged by the standards set by evolution). HDA creates a hybrid model that can integrate perspectives of the BST (i.e. by considering internal organ functioning); and the HTH (i.e. by considering external societal/goal functioning). However, while HDA may define health processes in relation to disease, it serves primarily as an integrative model of disease . Is there an integrative model of health that can account for natural and value-laden functions?

Schroeder ( 2012 ) identifies a significant, common thread among these competing (or perhaps complementing) philosophies: functionalism . The researcher suggests that each philosophy is concerned with the functioning of organisms. Although the BST, HTH, and the HDA might not agree on which functions inform the first principles of health, Schroder ( 2012 ) uses higher-level abstraction to identify one common first principle: the state of functioning in an organism impacts its state of health . When paralleling the three philosophies based upon functioning one might observe that (1) BST declares an individual healthy if its organs function normally; (2) HTH declares an individual healthy if he/she can function in relation to vital goals; and (3) HDA declares an individual unhealthy if internal mechanisms cannot perform natural, evolutionary functions, and/or when a condition prevents a person from functioning in relation to goals/norms/values. Through this higher-level abstraction, an integration of seemingly separate philosophies of health is made possible.

Learning from leaders in the field

As we attend to these philosophies of health, we too observe how discussions about functions and functioning produce integrative perspectives. Although a definition of “function” is not explicitly stated in the above research, it appears that Nordenfeldt ( 2007 ), Boorse ( 1997 ), Wakefield ( 2014 ), and Schroeder ( 2012 ) are each discussing functions as pre-existent (i.e. either from evolution, personal goal-setting, cultural tradition) processes - with - purposes . Whether one is describing a value-laden function (e.g. decision-making in pursuit of a valuable career) or an evolutionary-biological function (e.g. the heart beating for circulation), each process (i.e. decision-making processes or cardiac processes) serves identifiable purposes (e.g. maintained financial stability or maintained blood flow). Whether an organ is functioning normally in relation to the body or a human being is functioning in relation to vital goals, it appears that both perspectives consider if an active “process” (i.e. an organ’s activity, an individual’s activity) can express its “purpose” (i.e. evolutionary-purpose, life-purpose).

In the present manuscript we will propose that naturalistic and holistic perspectives can be integrated within a single philosophy of health. We will propose two universal functions—termed precision and variation —that can account for both natural functions and value-laden functions of the existing philosophies. This functional language will support a higher level of abstraction that integrates, rather than separates, biological functions, behavioral functions, and social functions under A Philosophy of Health.

The need for new perspectives in population health

The chronic disease crisis beckons the need for an updated philosophy of health that can account for biological, behavioral, and social functioning. Why? Chronic diseases, which account for 60% of all-cause deaths worldwide (Chartier and Cawthorpe, 2016 ), do not emerge from naturalistic, biological, or physical contact with an illness. Rather, chronic diseases do emerge in biological functions (e.g. tumor proliferation in an organ) after prolonged contact with health risk behaviors and lifestyle factors that active the conditions (Mokdad et al., 2018 ; Edington, 2009 ; Li et al., 2018 ). Chronic diseases are not curable by purely naturalistic or biological means (e.g. pharmaceuticals). Rather, some diseases may be effectively prevented or intervened on through healthy behavior (Dansinger et al., 2005 ; Daubenmier et al., 2007 ).

Population health risk behaviors are unique determinants of population health because researchers can actively observe how they simultaneously alter biological functioning (e.g. chronic smoking alters cells in lung tissue), behavioral functioning (e.g. chronic smoking alters decision-making and daily habits) and social functioning (e.g. chronic smoking creates an economic, social, and healthcare burden) of the population. These behaviors not only have biological, behavioral, and social implications for the individual doing the behavior, but also have intergenerational and interpersonal effects. The individual who binges on refined sugar not only puts themselves at risk of diabetes, but can put their future offspring at risk. The individual who smokes two packs of cigarettes per day not only puts themselves at risk of lung cancer, but can put their housemates at risk of lung cancer from second-hand smoke. Therefore, the chronic disease crisis is neither purely naturalistic, nor purely value-laden; rather it reflects an integration of natural and value-laden phenomena. There remains a real need for principles of health that can integrate existing naturalistic and holistic perspectives of population health.

The principles

Since April 7, 1948, the Constitution of the World Health Organization ( 2010 ) has utilized an intuitive definition of health by suggesting that health is “a state of complete physical, mental, and social well-being.” While this definition might be intuitive and even accessible to a wide audience; the defininition is not necessarily researchable across health disciplines. Integrating principles of health might begin with a common-sense definition of health that can also be upheld across existing naturalistic and holistic perspectives. Without operationally defining functions that drive physical, mental, and social well-being, it is a challenge for multidisciplinary collaborators to unite under the WHO mission. Further, without a common definition of health, important communications from patients to doctors, from subjects to researchers, from researchers to collaborators, and from peer-reviewers to peer-reviewees, can become fragmented or lost in translation. In the proceeding sections, a common-sense definition of health is used to present the first principles of A Philosophy of Health.

Principle 1: “Health” is the state of maintainable-ease of functioning . A “disease” is a state of prolonged-dysfunction that prevents ease

Chronic diseases emerge from prolonged exposure to dysfunctional behaviors like smoking, alcohol abuse, unhealthy diet, and inactivity (Mokdad et al., 2018 ) that also create dysfunctional expressions of life functions. Smoking creates dysfunctional breathing; alcohol abuse creates dysfunctional drinking; sugar binging creates dysfunctional eating; and sedentary behavior creates dysfunctional moving. When these health risk behaviors lead to chronic disease, they have already prolonged dysfunctional breathing, drinking, eating, and/or moving.

The chronic smoker breathes in smoke so frequently that he no longer experiences an ease-of-breathing. Rather, his breathing becomes short and shallow. Prior to the emergence of lung tumors, the chronic smoker prolongs dysfunctional patterns of breathing. The “couch potato” sits so frequently that he no longer experiences an ease-of-movement. Rather his movement becomes rigid and limited. Prior to the emergence of cardiovascular dysfunction or obesity, the sedentary person prolongs dysfunctional patterns of movement.

If chronic smoking facilitates prolonged-dysfunction in breathing, and sedentary behavior facilitates prolonged-dysfunction in movement, what do functional breathing and moving look like? Healthy breathing and moving (as well as eating and drinking) are characteristic of an ease of one’s functioning that can be maintained in normal conditions. For example, the chronic smoker and the “couch potato” might report momentary-ease in breathing and posture when engaging in their health risk behaviors; but they do not maintain that ease outside of smoking or sitting. Conversely, the yogi might report that their yoga practices expose them to momentary dis-ease in breathing and moving that lead to maintainable-ease in breathing and movement in everyday life. In contrast to disease as a prolonged-dysfunction, healthy functioning can be commonly sensed as a maintainable - ease of functioning .

When observing a disease, perhaps we are observing a prolonged-dysfunction that prevents ease. Rather than define health as the absence of disease (as seen in BST), notice here how we instead define disease in relation to health; and we define health in relation to maintainability , ease , and functioning . Consideration of “maintainable-ease of functioning” will allow us to consider how not all “dis-ease” is bad (i.e. exposure to acute dis-ease/stress maintains healthy functioning in the long-term); and not all “ease” is good (i.e. avoidance of stress and prolonged “comfort” creates fragility seen in sedentary behavior). We propose that:

Dysfunction parallels a state of “dis-ease”; and prolonged -dysfunction parallels the state of Disease.

Function parallels a state of “ease”; and maintainable-ease of functioning parallels the state of Health.

This definition of health will be applied in the proceeding principles to integrate naturalistic and holistic perspectives of population health.

Principle 2: Health emerges from maintainable-ease of functioning at multiple levels . Maintainable-ease of functioning in the general population can be observed at the level of the cell , the self , and the society simultaneously

Cooperation across multiple levels of functioning is required for the organization and adaptation of living systems (Nowak and Sigmund, 2005 ; Antonucci and Webster, 2014 ). When developing an integrative model of health, it is important to consider how biological cells, individuals, and the larger society simultaneously play a role in population health (Xavier da Silveira dos Santos and Liberali, 2019 ; Antonucci and Webster, 2014 ). In this philosophy, we define health from three levels: cells , selves, and societies . What happens when these levels do not function in cooperation?

When the functioning of cells disrupts the functioning of the self, a state dis-ease in the self can follow. For example, prolonged dysfunction in autoimmune conditions can lead to prolonged dysfunction for the (individual’s sense of) self by triggering depression, decreased motivation, or anxiety (Lougee et al., 2000 ; Garud et al., 2009 ). The reverse can also be true. When the functioning of the self (i.e. one individual) disrupts the functioning of their cells, a state dis-ease in the cells can also follow. For example, prolonged sugar binging and addictive eating can lead to prolonged high blood sugar and pancreatic dysfunction seen in diabetes (De Koning et al., 2011 ; Imamura et al., 2015 ). Cells and selves are not separate.

When the functioning of the self disrupts the functioning of the society we observe a state dis-ease in the society. For example, one person’s unprotected sex with multiple partners can also lead to epidemics and social conflicts. The reverse can also be true. When the functioning of the society disrupts the functioning of the individual, a state dis-ease in the self can follow. For example, dysfunctional social conditions (as seen in Rutter, 1998 ), can lead to prolonged psychological and behavioral dysfunctions of individuals. Selves and societies are not separate.

When the functioning of society disrupts the functioning of cells, a state of dis-ease in the cells can also follow. For example, prolonged dysfunction in society in the form of misguided values about cleanliness, can lead to over-sanitization practices that create superbugs and antibiotic-resistant bacteria (Zaccheo et al., 2017 ; Finkelstein et al., 2014 ; Bower and Daeschel, 1999 ). The reverse can also be true. When the functioning of cells disrupts the functioning of the society, a state of dis-ease in the society can follow. Prolonged dysfunction in cells from naturally occurring parasites (e.g. Yersinia pestis [Cui et al., 2013 ]) can lead to prolonged dysfunctions like the economic collapse following 14th century Black Death (Haensch et al., 2010 ). Cells and societies are not separate.

What does health look like when these levels work together? Recent reports on the Blue Zones (i.e. the areas of the world where populations live significantly longer and healthier than the average) demonstrate that healthy functioning at these levels enhances physical longevity and mental wellbeing in populations (Buettner, 2012 ; Poulain et al., 2013 ). Buettner ( 2012 ) reports on how Blue-Zone populations intentionally and habitually enrich their physical bodies with healthy eating and physical activity. In addition to integrating physical and behavioral practices, these communities also integrate behavioral and social practices, such as, goal-setting, meditations/prayer, social engagement, pursuit of purpose, and community gathering. Humor is used by individuals and groups as a means to practice ease when challenges present themselves (Buettner, 2012 ). Blue Zone communities place value upon physical/natural, behavioral and social processes, generating them intentionally and habitually.

Both states of ease and dis-ease can teach us about the contributions of cells, selves, and societies to population health. Although it is important to be able to observe the levels separately to describe their contributions, it is also important to consider how the levels integrate to impact healthy publics. We acknowledge that meaningful changes can be observed above and below these levels (e.g. at the level of the biosphere and genome). However, this initial paper will introduce levels that are most proximal and accessible to the experience of a general readership (Fig. 1 ).

Principle 3: Health emerges from systems whose primary purpose is to generate maintainable-ease of functioning at a respective level

We propose that systems exist at each level with the purpose of generating maintainable-ease of functioning at that level. The biological immune system, an individual’s system of health behaviors, and the social system will be observed as systems that generate maintainable-ease of functioning in cells, selves, and societies respectively (Fig. 2 ).

Principle 3a: The biological immune system is directly responsible for maintainable-ease of functioning at the level of the cell

Throughout the course of human evolution, the complexity and biodiversity of the human body continued to increase (Rodríguez et al., 2012 ). What keeps the trillions of cells and microorganisms in cooperation in a human body? The biological immune system maintains functional cells (Rodríguez et al., 2012 ). Although it is documented that the functioning of the biological immune system has implications for behavioral functioning (Ader, 1974 , 2000 ; Johnston et al., 1992 ; CDC, 2016 ) and social functioning (CDC, 2016 ; Reidel, 2005 ; Cutler and Miller, 2005 ) the system’s primary purpose is supporting functioning in the cellular/biological system.

Principle 3b: Health behavior is directly responsible for maintainable-ease of functioning at the level of the self

Throughout the course of time, the complexity of human behavior, has continued to increase (Boulding and Khalil, 2002 ). What keeps an individual in a state of balance during times of rapid change? One’s system of health behaviors (e.g. one’s practices of breathing, drinking, eating, and moving) maintain a functional self. Although it is well documented that the behavior of the individual impacts biological functioning (Fadel, 2013 , 2015 ) and social functioning (Omer et al., 2009 ), one’s system of health behaviors directly impacts one’s experience of (or one’s ‘sense of’) their “self”.

Principle 3c: The social system is directly responsible for maintainable-ease of functioning at the level of the society

Throughout history, the social diversity of human societies continued to increase. During periods of rapid increases in social diversity and cultural integration, what supported cooperation in the society? Social systems (e.g. public governments, private social organizations, religious/spiritual organizations) emerge to maintain a functional society. Although it is well documented that a social system can impact biological functioning (CDC, 2016 ; Riedel, 2005 ; Cutler and Miller, 2005 ) and behavioral functioning (Buettner, 2012 ), the social system’s primary role is to maintain functions at the level of the society.

Principle 3d: By considering health as maintainable-ease of functioning generated by systems , we have the ability generalize health across levels

To observe health at the level of the cell, the self, and the society simultaneously, we consider systems that support maintainable-ease of biological, behavioral, and social functioning. The biological immune system, an individual’s system of health behaviors, and the social system make meaningful contributions to the functioning of cells, selves, and societies, respectively. While these systems are not the only systems that impact each level (e.g. one’s cardiovascular system impacts cells, one’s “personality” impacts the self, the environment impacts society), the biological immune system, health behavior, and the social system have great implications for population health from their respective levels; and they can be operationalized at these levels based upon their functions .

By considering health as maintainable-ease of functioning (rather than maintained biological structures) at multiple levels, we set a point of reference from which to integrate important determinants of population health. When taking the structuralist’s perspective, the biological immune system, health behavior, and social systems appear as distinctly separated. When taking a functionalist’s perspective, the biological immune system (i.e. the integration of host defense functions and microbiota functions), one’s (system of) health behaviors (i.e. the integration of decision-making/executive functions and habits/habitual life functions), and the social system (i.e. the integration of population values and population behaviors) appear together in A Philosophy of Health.

Principle 4: Each system employs two general functions— variation and precision —to generate maintainable-ease of functioning at a level

The functionalist perspective allows us to observe systems based upon their functions . The biological immune system will be observed as an integration of host defense functions and microbiota functions (Hooper and Littman Macpherson, 2012 ); (2) an individual’s system of health behaviors will be observed as an integration of decisions/executive functions and habits/habitual life functions (de Bruin et al., 2016 ; Verplankern, 2005 ; Norman et al., 1998 ; Prochaska et al., 1994 ; Prochaska et al., 1991 ); and the social system will be observed as an integration of actively functioning values and population-wide behaviors that function in relation to those values (Dowling and Pfeffer, 1975 ; Cotgrove and Duff, 1981 ).

By researching the role of these functions at each level, we distilled two general functions of each system: variation and precision. Variation appears in the functions of each system that generate a range of abilities, the “varied-abilities”, that sustain health in presently changing conditions. The microbiota, habits/habitual life functions and population behaviors will be observed (in Principle 4a) as the variation-functions of the biological immune system, health behavior, and the social system, respectively. Precision appears in those functions that prioritize and organize the patterns of variation that can sustain health at a level in future, changing conditions. The host-defense functions, decision-making/executive functions, and values systems will be observed (in Principle 4b) as the precision-functions in the biological immune system, health behavior, and the social system, respectively.

Consideration of a complementary relationship among precision and variation is not novel. Precision and variation have been discussed as central to the development of neural and biological systems (Hiesinger and Bassem, 2018 ). Discussions of precision and variation have also provided important insight into research on the biological immune system (Albert-Vega et al., 2018 ; Brodin et al., 2015 ). Through this philosophy, one can go beyond biological systems to observe how precision (in the form of host-defense functions, decision-making/executive functions, and values) and variation (in the form of microbiota functions, habits/habitual life functions, and population-wide behaviors) integrate to generate to maintainable-ease of functioning in cells, selves, and societies simultaneously (Fig. 3 ).

Principle 4a: Variation is responsible for generating the range of abilities, the “varied-abilities”, that can express ease-of-functioning in presently changing conditions

Without functional variation, life is fragile because the present environment is always changing (Taleb and Blyth, 2011 ). Fragile systems’ inability to experience changing conditions (in part) relates to limited variability. Conversely, adaptive system’s ability to experience changing conditions (in part) relates to functional variability (Taleb, 2012 ). When one microorganism in the microbiome takes over, biological fragility reflects a state of infection. When one habit takes over, behavioral fragility reflects a state of an addiction/dependence. When one population behavior takes over (e.g. when economic participation or access to food is restricted to a small percentage of the population) social fragility reflects a state of social/civil unrest.

The human microbiota is comprised of trillions of microorganisms, such as bacteria, fungi, and viruses. When variability in the human microbiota exists, an ease of functioning, or “homeostasis” in cells can be expressed in the present biological/ecological environment (Parfrey and Knight, 2012 ; Bogaert et al., 2011 ; Claesson et al., 2011 ). Research demonstrates that variation in the microbiota impacts the health of human cells by metabolizing complex carbohydrates, converting proteins to neural signals, and modulating diurnal rhythms that maintain biological homeostasis (Clemente et al., 2012 ; Rothe and Blaut, 2012 ; Blaut and Clavel, 2007 ; De Vadder et al., 2014 ). When variation in the microbiota is dramatically limited or changed (e.g. following antibiotic overuse), cellular tissue in the human body is fragile and vulnerable to infections, allergies, and inflammatory outbreaks (Francino, 2016 ).

When one’s habitual life functions (e.g. breathing, drinking, eating, and moving) and one’s healthy habits (e.g. one’s weekly exercise schedule, or weekly meal preparation) can be expressed freely, an ease of functioning is felt by one-self in the present environment. When life functions are no longer expressed with ease (e.g. breathing and movement are compromised due to prolonged sedentary lifestyle), or when a single habit takes over one’s lifestyle (e.g. smokes breaks “must” occur every 30 min), an individual is vulnerable to stressful outbreaks and chronic states (Al’Absi, 2011 ; Conrad et al., 2007 ; Suess et al., 1980 ; León and Sheen, 2003 ; Parrott, 1999 ; Koob, 2008 ).

When the basic human rights in a society are preserved in the present (e.g. right to life, freedom of speech; right to property), human populations have the ability to freely engage in the population - wide behaviors (e.g. health behaviors, social behaviors, economic behaviors) that support a functioning society. Health behaviors drive health and longevity. Social behaviors drive communication and cooperation. Economic behaviors drive goods and resources. When these population-wide behaviors are chronically restricted in a population (e.g. poor access to health care, oppression of free-speech, economic crash), societies become vulnerable to social/civil unrest [as commented historically by Victor Frankl ( 1985 ), Alexander Solzhenitsyn ( 2003 ), Franklin D. Roosevelt ( 1941 ), and Dr. Martin Luther King ( 1985 )].

Variation is essential so that a system has varied-abilities that can express ease-of-functioning in present environmental conditions . Dramatic and prolonged restrictions to variation in the microbiota, habits/habitual life functions, and population-wide behaviors characterize fragile and vulnerable states in cells, selves, and societies. Conversely, functional-variation supports resilience, robustness, and antifragility (Taleb, 2012 ). This does not mean that infinite variation is desirable; however, in this philosophy, precision is responsible for organizing expressions of variation so that the system does not degrade into unpredictably random variation or chaos (see Principle 4b).

Principle 4b: Precision is responsible for prioritizing and organizing the patterns of variation that maintain ease-of-functioning in future, changing conditions

Some environmental changes are too challenging for ease to be expressed in the present. However, following an exposure to challenging conditions, some systems adapt and become more functional (Taleb, 2012 ). Without the ability to functionally organize after stressors, a system degrades into disorder or chaos over time. Host-defense functions, decision-making/executive functions and values systems prioritize and organize variation in the microbiota, habits/habitual life functions, and population behaviors respectively.

When a pathogen invades the biological system, precise responses must occur to organize this potentially chaotic situation. At the level of the cell, a functional host-defense system (comprised of the innate, adaptive and complement immune system branches) organizes the biological system so that functional invaders (i.e. symbionts) and healthy cells are maintained and dysfunctional invaders (i.e. pathogens) and damaged cells are removed (Hoeb et al., 2004 ; Janeway, 1992 ; Janeway and Medzhitov, 2002 ; Janeway et al., 2014 ). When precision is dysfunctional, the host-defense system may (1) fail to prioritize responses to a costly invasion, leading to a state of infection; or (2) the host-defense system might prioritize dysfunctional responses to the cells of body that prolong a state of autoimmunity (Naor and Tarcic, 1982 ).

When a bad habit emerges, precise responses must occur to organize this potentially chaotic situation. At the level of the self, functional decision-making (or at smaller scales executive functioning) prioritizes and organizes behavior so that functional expressions of habit (or at smaller scales, habitual life functions) are prioritized regularly, and dysfunctional ones are replaced or minimized (de Bruin et al., 2016 ; Prochaska et al., 1994 ; Prochaska and Prochaska, 2016 ; Prochaska et al., 1988 ; Redding et al., 2011 ; Weissenborn and Duka, 2003 ; Bickel et al., 2012 ). When dysfunctional, decisions may (1) fail to prioritize responses that remove a costly expression of habit (e.g. a teen started smoking cigarettes to “be cool” and now has to smoke in the bathroom before each class to get through the day; by not deciding to move at work, one’s breathing becomes shallow and movement becomes rigid); or decisions may (2) prioritize habits that prolong dysfunction despite knowing the dangerous consequences (e.g. an adult continues smoking cigarettes despite knowing the family’s history of lung cancer; an adolescent continues binge on sugar despite a diabetes diagnosis).

When dangerous population-wide behaviors threaten life in a society, precise responses must occur to organize this potentially chaotic situation. At the level of society, the agreed upon values organize the social system so that functional population behaviors are prioritized and dysfunctional population behaviors are minimized. Functional values prioritize behaviors that support the society (e.g. as seen when societies mandate that students get certain vaccines before attending University), while also setting standards that remove/replace behaviors that threaten the society (e.g. new laws create legal repercussions for risk behaviors in society). Without values that functionally prioritize population-wide behavior, society may (1) fail to prioritize responses to a dysfunctional population behavior (e.g. as seen during AIDS epidemic of the 1980s due to insufficient public health values around safe sex); or society may (2) prioritize dangerous behaviors that can prolong societal dysfunction (e.g. the antibiotic resistance crisis (Ventola, 2015 ; Michael et al., 2014 ) has been attributed in part to the over-valuing or over-use of antibiotic medications in healthcare practices).

Precision is essential so that a system can maintain ease-of-functioning in future, changing conditions . When precision does not adequately detect the presence of costly conditions, a response may not be prioritized (e.g. as seen during acute infection, addiction/dependence following a surgery, the AIDs outbreak in the 1980s). When precision prioritizes responses that prevent ease longitudinally, dysfunction is prolonged (e.g. autoimmunity, continued smoking despite family history of cancer, misguided values that create an antibiotic-resistant bacteria). Through dysfunctional -precision, the conditions for life in cells, selves, and societies becomes disordered over time. Through functional -precision, a system prioritizes responses that maintain ease-of-functioning in future conditions. Prioritizing functional microorganisms (i.e. symbionts) supports the developing life of cells; prioritizing functional habits (e.g. weekly exercise) and habitual life functions (e.g. diaphragmatic breathing and relaxed movement) supports the developing life of the self; and prioritizing functional population behaviors (e.g. access to functional health care, economic resources; access to social support) supports the developing life of the society.

Principle 5: Health is valued by a system when precision-and-variation generate maintainable-ease of functioning. Health is de-valued by a system when precision or variation prevent maintainable-ease of functioning

By defining precision-and-variation, we can better understand maintainable-ease of functioning in population health:

Functional-Variation generates ease-of-functioning in the present (e.g. fluid and variable motion reflects an ease and variability of one’s movement); while Functional-Precision prioritizes expressions that can maintain ease-of-functioning in the future (e.g. prioritizing challenging exercise for 20 min each day may lead to an ease in bodily movement long term).

Dysfunctional-Variation prevents ease-of-functioning in the present (e.g. prolonged sitting might lead to rigid movement and shallow breathing); while Dysfunctional-Precision might prioritize expressions that prevent ease in the future (e.g. rather than focus on relaxing breathing and movement on work breaks, one decides to drink alcohol to relax).

Without functional-variation, life is fragile and vulnerable to changing conditions of the present. Without functional-precision, life becomes disorganized from the system’s exposure to changing conditions across time. When functional-and-integrated, precision-and-variation value maintainable-ease of functioning in cells, selves, and societies. When dysfunctional or fragmented, precision or variation can de-value maintainable-ease of functioning in cells, selves, or societies. If maintainable-ease of functioning can be valued in cells, selves, and societies, we will likely observe healthy publics.

Five principles of health are presented: (1) Health is the maintainable-ease of functioning; (2) Maintainable-ease of functioning emerges from multiple levels ; (3) At each level, maintainable-ease of functioning is generated by systems ; (4) Each system employs two functions, precision - and - variation , that generate maintainable-ease of functioning ; and (5) Health is valued by a system if precision-and-variation generate maintainable-ease of functioning. Through these five principles, both naturalistic and holistic perspectives can be considered simultaneously because maintainable-ease of functioning is relevant to biological functioning (e.g. as described in BST) and personal/social, goal-oriented functioning (e.g. as described in HTH). This philosophy can also be used to investigate how naturalistic and holistic phenomena have informed past healthcare interventions. What do vaccine interventions, behavior change interventions, and social change interventions have in common? When successful, these interventions enhance both precision and variation.

Vaccine interventions can enhance both the precision of the host-defense functions and variation in the microbiome. During a vaccine intervention, the microbiome is exposed to a new variation in the form of a new virus (Reidel, 2005 ). Through this exposure, the precision of host defense functions can adapt to prioritize maintainable-ease of functioning in the microbiome in the future. How? The host-defense system produces antibodies that allow the immune system to respond effectively and efficiently to this virus when exposed to it again in the future (Janeyway, 2014 ). Although the precision of the immune system has been enhanced to handle historical threats through vaccines (e.g. for small pox, chickenpox, measles), new viruses like the coronavirus can still emerge. With this philosophy, vaccine developers and public health officials might not only ask the question, “How do we combat the coronavirus?” Researchers, vaccine developers and public health officials may also ask the functional question: “How do we enhance the precision of the host-defense system and the variation of the human microbiome to adapt following an exposure to the coronavirus?”

Behavior change interventions can enhance both the precision in one’s decisions and the variation in one’s habits. During a behavior change intervention, a person’s existing habits are exposed to a new variation in habit. For example, the beginning of a new exercise intervention exposes the individual’s current habits/habitual functioning to changes in movement and breathing (i.e. exercise) that may also change their patterns of eating and hydration. Through this exposure, a person’s decision-making might adapt to prioritize maintainable-ease of functioning in the individual’s lifestyle. How? Some behavior change interventions train one’s decision-making to remove or “counter-condition” unhealthy habits, by replacing them with healthy habits (Prochaska et al., 1988 ). Although modern behavior change interventions have shaped the precision of decision-making during health behavior change (e.g. of smoking, diet, alcohol use, inactivity), new problems for health behavior still emerge when the individual is exposed to a new, potentially addictive technology. With this philosophy, behavior change interventionists and health officials might not only ask the question, “How do we support good decision-making of individuals?” Researchers, behavior change technology developers, and public health officials may also ask the functional question: “How do we enhance the precision of one’s decisions and the variation of one’s habits following the exposure to a new, potentially addictive technology?”

Public health campaigns disseminated by social organizations can enhance the precision of the population’s health values and variation in population-wide health behaviors. Leading up to first Surgeon General’s Advisory Committee on Smoking and Health (1964), the U.S. Department of Health had become increasingly aware of (i.e. exposed to) variations in a population health behavior. If populations smoked, then populations were more likely to develop lung cancer, laryngeal cancer, or chronic bronchitis (CDC, 2018 ). Following this exposure to (the consequences of) population smoking behavior, society’s values shifted to prioritize health. How? The Federal Cigarette Labeling and Advertising Act of 1965 was adopted, and the Public Health Cigarette Smoking Act of 1969 was adopted to create new health values. This shift in values prioritized new variations in population health behavior by: (1) requiring a health warning on cigarette packages; (2) banning cigarette advertising in the broadcasting media; and (3) calling for an annual report on the health consequences of smoking (CDC, 2018 ). Since these first initiatives adult smoking rates have fallen from about 43% (in 1965) to about 18% today; and mortality rates from lung cancer, the leading cause of cancer death, are declining (Department of Health and Human Services, 2014 ). Although the precision of the population’s values has been enhanced to impact population behaviors (e.g. the tobacco laws described above supported healthy change), new chronic states can still emerge following exposure to social changes (e.g. the invention of the Juul impacted high school and college aged populations). With this philosophy, public policy officials and public health researchers might not only ask the question, “How do we create new laws to protect population health from nicotine addiction?” They may also ask the functional question: “How do we enhance the precision of the population’s values and the variation of the population’s behavior following the invention of a new nicotine delivery system technology (e.g. flavored Juuls)?”

Previously we described that without functional variation, life is fragile when exposed to present changing conditions; and without functional precision, life becomes disorganized from exposure to changing conditions across time. When successful, the above interventions upon biological, behavioral, and social functioning have a common theme: each facilitates exposures to biological, behavioral or social conditions that support (1) increasingly complex/diverse variation; and (2) increasingly organizable precision. Exposure, not avoidance , has facilitated population health in these interventions. While healthcare systematically prioritizes biological exposures in the form of vaccine interventions, they do not systematically prioritize behavioral or social exposures. However, it is documented that exposure to healthy behaviors in youth prevents risk behaviors in adolescence (Velicer et al., 2000 ); and exposure to community-based health initiatives can support population health (Dulin et al., 2018 ; CDC, 2018 ). Given that systematic biological exposures in the form of vaccination have led to a global control of some acute infectious diseases (Tangermann et al., 2007 ); might systematic behavioral and social exposures (especially in youth) be needed to enhance global campaigns toward the control of chronic disease?

A functional language of health is central to the success of a Philosophy of Health. Why? The levels are not separate, but rather are continuously connecting with one another. A good philosophy of health should have the ability to discuss assessment, diagnosis, intervention, and prevention across levels, across systems, across cultural populations, and across time. Using the common language of precision and variation creates discussions that connect the levels and integrate research disciplines.

A case (to) study: mental health as between-level functioning in this philosophy

Historically, and still too often, health professionals have an expertise at one level, that limits their prescription of interventions to that level. This can actually create barriers to a complete solution when a health problem is multileveled. While a person’s mental health is typically assessed based upon their first-person experience of thoughts, feelings, and behaviors; symptoms can be triggered by biological, physiological, behavioral, psychological, and/or social dysfunction. Most clinicians typically do not have the ability to assess and address all forms functioning. So if one person, John, is meeting with a clinician who specializes in primary care medicine, he may only be prescribed a biological intervention like medication. If John is meeting with a clinician who specializes in behavioral medicine, he may only be prescribed a health behavior change intervention. If John is meeting with a clinician who specializes in a certain theory of psychotherapy, he may only be prescribed a psychotherapy intervention based on the clinician’s training. If John is meeting with a clinician who specializes in social work, he may only be prescribed a group, community or social intervention. While the above specializations have been helpful in establishing an empirical bases for mental health interventions, over-specialization can be problematic when a multi-leveled solution is needed. In addition, it can also be problematic when a level-specific solution is needed that the clinician cannot provide (e.g. when psychotherapy is needed but a clinician only has the ability to prescribe psychiatric medication).

Technology poses a multileveled issue for population mental health in 2020. Selves have more social connection then ever in history, yet societies are characterized by increasing rates of depression and loneliness (Sum et al., 2008 ; Hammond, 2020 ; Srivastava and Tiwari, 2013 ; Twenge, 2017 ). Researchers might use this Philosophy of Health to facilitate between-level conversations that address seemingly paradoxical outcomes that emerge during this new age of rapid technological growth. To do this, a researcher might first begin by asking questions about functioning at each level ; second , ask questions about processes between the levels ; and third , concurrently ask questions at and between levels .

First: Begin by asking questions at each level

Novel challenges face the iGeneration (and their parents) due to technology’s novel impacts on the development of individual and social functioning (Twenge, 2017 ). For example, if John’s decisions (self-precision) and habits (self-variation) remain consistent during school hours because his parents do not let him have a phone; but his class’ social behaviors around him (society-variation) change dramatically because everyone else at school uses the newest smartphone application to talk during class; will John’s mental health suffer? Although his parents’ intentions are to protect John, the contrast between his behavior (self’s precision-and-variation) and the population social behavior (society-variation) can impact John’s health. Notice here how we have not yet considered functions that connect the self to the society (e.g. John’s thoughts and feelings). Rather we first consider (or contrast) functioning at the level of the self (i.e. John’s decisions-and-habits) and the society (i.e. population social behavior) in accordance with Principles 1–5 (see Figs 1 – 3 ).

Second: Look for functional processes that connect the levels

One person’s thoughts and emotions/feelings are processes that help to integrate the functioning of one-self within the functioning of a society. How might John’s thoughts and feelings connect his (sense of) self to his society? Perhaps John’s parents teach him that it is important to feel separate from his classmates during class so he can think clearly in class; and that he can feel connected to his friends by inviting them over to communicate together after school. This parenting may impact John’s thoughts and feelings during school. If John’s parents do not talk with him about this topic, John may experience different thoughts and feelings during school hours. When kept to one-self, thoughts and emotions are foundational to an internal sense of self as one functions in the larger society; and, when acted upon, thoughts and feelings can become verbal communication (e.g. speech) and non-verbal communication (e.g. body language, facial expressions) that form an external sense of self that is visible to the society. The (internal) experience of and (external) communication of thoughts, feelings and actions form the foundation of all systems of psychotherapy (Prochaska and Norcross, 2018 ). This view can be particularly helpful as researchers begin to investigate how smart technology impacts developmental changes to the self within the society beginning in youth.

Third: Concurrently ask questions at and between levels

Perhaps, a clinical researcher is interested in investigating protective mental health factors in the iGeneration; and they hypothesize that lower rates of loneliness, anxiety, and depression will be seen in subjects that do not respond to text messages immediately. The researcher might investigate further by using the philosophy to develop questions for the research subjects: “(1) Do you use conscious decision-making (self-precision) to prevent yourself from habitually responding to your phone when a text appears (self-variation)? (2) How fast do other’s in your social group typically respond to texts (society-variation)? (3) What changes in thoughts and feelings are experienced (internal self-society connection) after you communicate via text (external self-society connection)?” Perhaps this researcher also wants to investigate how those who are addicted to the technology perceive non-responders. The clinical researcher might again apply the philosophy: “(1) How fast do other’s in your social group typically respond to your texts (society-variation)? (2) Do you experience changes in thought and feeling (internal self-society connection) when others do not respond to you within an hour (society-variation)? (3) How do you communicate those thoughts and feelings (external self-society connection) with others when they do not respond for a prolonged period of time (society-variation)?” Future research might use this method to gather and organize levels of information on mental health factors across different self- and societal-conditions.

The processes that form our mental health form a functional connection between self and society. If mental health is a reflection of the self–society connection, what might be a reflection of the self–cell connection? Physiological health evidences a functional connection between our sense of self and our cells. For example, aerobic exercise is a health behavior that stimulates changes to variations in breathing and movement. By engaging in this behavior, the biological cells of the body are also stimulated via various physiological processes. Breathing will stimulate cellular functioning via the cardiovascular and respiratory systems; and movement will stimulate cellular functioning via the cardiovascular, musculoskeletal, and central nervous systems. While all physiological systems are working in collaboration in the body, certain changes to behavioral and biological functioning will stimulate certain physiological systems. By viewing health through this lens, between-level observations join the philosophy: biological functions emerge at the level of the cell; physiological functioning emerges as the cell–self connection; behavioral functions emerge at the level of the self; psychological/mental functioning emerges as the self–society connection; and social functions emerge at the level of the society. Future papers will explore maintainable-ease of functioning at and between levels.

Future directions: new images of healthcare integration and new perspectives of healthcare innovation

By considering this integrative philosophy, one can define health based upon a tangible connectedness, rather than separateness, of cells, selves, and societies. We provide Image 4 as a way to visualize the common paths to the health of healthy publics. When researchers observe that a host defense system is changing cellular functions following an infection, they may also expect these changes to have an impact [along Path 1] on expressions of habitual or physiological functions (e.g. immune function can stimulate the sensation of “achiness” or “pain” altering one’s physical movement, breath rate, hydration, and hunger) (Kelley, 2003 ; Johnson et al., 1992 ; Danzer, 2009 ). When researchers observe an individual deciding to engage in health behavior change following an addiction, they may also expect these changes to have an impact [along Path 2] on the group-behavior of their family system or social systems. When researchers observe changes to society’s values following a newly detected problem (e.g. laws ban Cigarette Advertising in broadcasting media; public health standards mandate certain vaccines before attending school), they may also expect that these changes can have an impact on behavioral functions of individuals [along Path 2] and biological functions of cells/organs [along Path 3]. These levels are continually integrating along these common paths to the health of healthy publics (Fig. 4 ).

When attending to this connectedness new, important questions can have new answers. What function does modern technology serve in population health and healthcare? If technology algorithms prioritize variations in population behaviors, then they fulfill a role as society-level precision. When modern technologies like machine learning (ML) technology and Computer Tailored Interventions (CTI) prioritize patterns of population behavior, we can see profound impacts on social change in a society. Although one might argue that technologies can be used by individual-level functions, the algorithms that are currently deployed and updated on devices interface with big-data gathered on population behaviors (Manogaran and Lopez, 2017 ; Dinov, 2016 ; Mullainathan and Spiess, 2017 ; Cheng et al., 2017 ).

In this paper, we identified that precision can be functional or dysfunctional. Similarly, technologies can support or prevent healthy population behavior. Some technologies prioritize health behavior in populations by tracking physical activity and providing feedback on activity progress; while others prevent healthy behavior by prioritizing sedentary behavior through video-gaming. Some social media technologies facilitate social communication with distant friends and relatives that supports wellbeing; while others facilitate conflictual communication that diminishes wellbeing. Given that modern technology can support or hinder health, we believe it is important that healthcare can prioritize technological innovations that value health in cells, selves, and societies. To do this, technology innovators might seek to value a higher order construct (e.g. maintainable-ease of functioning) in their algorithms.

Medical technology is currently used to titrate the doses of vaccines so that maintainable-ease of biological functioning (i.e. inoculation) is made available to the general population. When biological exposures are not properly titrated, infections can become active in the population and health is no longer valued at the level of the cell. Similarly, when behavioral and social exposures are not tailored to the needs of individuals and groups, populations can become resistant to healthy change, and health is no longer valued at the level of the self and the society. Behavior change researchers Prochaska and Prochaska ( 2016 ) report that when individuals and populations are not ready for a change, interventions that force individuals or populations to take action can increase resistance and prolong dysfunction. By tailoring (or what they term “staging”) behavioral and social level interventions, Computer Tailored Interventions upon behavioral and social functioning are made possible (Prochaska et al., 2001 ; Velicer et al., 2000 , Prochaska and Prochaska, 2016 ). Despite these advances, there remains a need for technological advances that can make maintainable-ease of behavioral and social functioning available to the general population.

Future healthcare interventions could benefit from ML algorithms that tailor behavioral and social exposures to enhance precision-and-variation. Research already demonstrates that tailoring interventions for biological precision (Albert-Vega et al., 2018 ) and biological variation (Brodin et al., 2015 ) can impact long-term biological functioning. Future innovations might seek to use technology to tailor behavioral and social interventions to generate maintainable-ease of functioning. Through the functional language used in this paper we hope readers are inspired to present new questions, new comments, and new perspectives about needed healthcare innovations.

This philosophy of health investigates three levels of health: cell, self, and society. The level of the cell accounts for biological functioning within human beings. The level of the self accounts for first-person functioning of each human being. The level of the society accounts for group functioning of human beings.

Each system is responsible for generating maintainable-ease of functioning at a level. The biological immune system is responsible at the level of the cell. A human's system of health behaviors is responsible at the level of the self. The social system is responsible at the level of the society.

Maintainable-ease of functioning is generated by two functions in each system: precision and variation. The human microbiota, habits, and population-wide behaviors evidence variation in cells, selves and societies respectively. The host defense system, decisions, and values evidence precision in cells, selves and societies respectively.

Population health is generated along common paths that integrate the levels. The biological functioing of cells impacts fluctuations of habits/habitual functioning; and vice versa. The behavioral functioning of each self impacts fluctuations in population behavior; and vice versa. The biological functioning of cells also can impact fluctations in population behavior; and vice versa.

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Health beliefs are what people believe about their health, what they think constitutes their health, what they consider the cause of their illness, and ways to overcome an illness it. These beliefs are, of course, culturally determined, and all come together to form larger health belief systems. Different cultures have different definitions of what constitutes health and what causes illness. Culture itself can be defined many ways, but it is basically the characteristics that comprise a group of people’s way of life, such as attitudes, beliefs, practices, etc.

Our thoughts and emotions follow our beliefs and create the attitudes, assumptions, expectations, and behaviors that determine how we react to life events and what we think is possible. These underlying belief systems drive our behavior. Similarly, health beliefs influence health behaviors and health outcomes. Results of clinical trials show that participants who received placebos have favorable responses to alleviating many...

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Misra, R., Kaster, E.C. (2012). Health Beliefs. In: Loue, S., Sajatovic, M. (eds) Encyclopedia of Immigrant Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5659-0_332

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Definition and background, examples in human biology and public health, example in clinical medicine, acknowledgements.

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Margarita Hernandez, James K. Gibb, Culture, behavior and health, Evolution, Medicine, and Public Health , Volume 2020, Issue 1, 2020, Pages 12–13, https://doi.org/10.1093/emph/eoz036

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Cultural behaviors have important implications for human health. Culture, a socially transmitted system of shared knowledge, beliefs and/or practices that varies across groups, and individuals within those groups, has been a critical mode of adaptation throughout the history of our species [ 1 ]. Socioeconomic status, gender, religion and moral values all play into how individuals experience, conceptualize and react to their world, and therefore general understandings of cultural groups are insufficient for grasping a patient’s unique experience with health and illnesses [ 2 , 3 ]. Additionally, structural inequalities and political economy play a critical, and often overlooked, role in health and disease [ 4 ]. Understanding how behaviors are rooted in an individual’s unique cultural experience and as a response to social pressures can better equip medical professionals with the context, skills and empathy necessary for holistic care [ 2 ].

Healthcare providers can improve individual outcomes by thoroughly factoring in life experiences as part of understanding an individual’s health and treating their illnesses. The use of a ‘mini-ethnography’ can help healthcare providers understand how identity, interpretation of illness and the moral values of patients factor into building a trusting relationship that considers the patient’s life experiences into treatment plans [ 3 ]. Table 1 summarizes this approach.

Kleinman and Benson’s approach to conducting a ‘mini-ethnography’ with every patient in order to best incorporate a patient’s culture into treatment plans [ 3 ]

In rural Bolivia, children of mothers with higher indices of local ecological knowledge (LEK) had reduced inflammation, taller height, and less hookworm infections than children of mothers with lower indices of LEK [ 5 , 6 ].

The Acholi people of Uganda have several cultural models for understanding and responding to disease outbreaks that were employed during the 2000 Ebola outbreak [ 7 ]. Acholi cultural practices related to gemo , or an epidemic outbreak, limit the spread of infectious diseases that may have occurred through traditional funerary practices, such as the washing and touching of deceased bodies [ 7 ].

Both examples highlight a need for understanding Indigenous knowledge systems as they relate to health and in responding to disease.

Understanding how social pressures, such as racism and discrimination, manifest biologically is critical in understanding how cultural behavior relates to health. In a sample of diverse pregnant women in New Zealand, those that experienced ethnic discrimination had high cortisol levels and their infants higher cortisol reactivity, suggesting a transgenerational effect of discrimination [ 8 ].

Margarita Hernandez is supported by National Science Foundation Grant No. DGE1255832.

Conflict of interest: None declared.

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Health Belief Model, Essay Example

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Researchers have always tried to establish the causes and remedy for diseases but there are researchers who chose to come up with something different. This is the health belief model that was designed as a tool for helping health officials study health behavior. The model is based on the assumption that the personal beliefs people have affect their health behaviors. Many people concerned with heath education have adopted this model and this is because it can simply be adapted to suit a health practice. Rosenstock, Strecher and Becker (1994) claim that the last three decades have seen wide use of the health belief model in health related behavior.   The health belief model was a 1950s development of several Public Health Service officials; Hochbaum, Rosenstock, Leventhal and Kegels.

The model was initially created with an aim of analyzing how people tended to use public health services provided by the U. S Public Health Service. This was prompted by tuberculosis service use which according to Hachbaum (1958) were proving to be unsuccessful. The model was adopted for the United States Public Health Service prevention programs. It contained four elements or perceptions which the researchers identified as important components that can help one understand health behavior. These perceptions have so far been increased and according to Rosenstock, Strecher and Becker (1994), they are perceived threat (perceived susceptibility and perceived severity), perceived benefits, perceived barriers, cues to action, other variables and self-efficacy. Gatewood et al. (2008) think that the purpose of the health belief model was to explain people’s lack of action in preventing asymptomatic disease. Thus, the health belief model was geared towards health related behavior which Glanz and Maddock (2002) think that the advancements in medicine as well as improvement in sanitation have increased its necessity.

Perceived Threat

Mackey (2002) asserts that the identification of health risks inherent in a community by its members is a determinant of their health. The threat perception people attach to a health condition in terms of how serious it is and their chances of being affected by it is what constitutes the perceived threat construct. For a health condition, people hold certain beliefs about how and what may happen if they contract it. One person may perceive a health concern as being severe while it may be less severe to another. There are many things that people use to determine the seriousness of a condition and when people know they are more at risk of losing something and would therefore be prompted to take action for their lives. Some people may decide to take action because they are aware of what it might cost them if they were to get sick. When it comes to susceptibility, someone may tend to think that because he/she is of a certain age, then the disease cannot affect him/her. Someone may also have the perception that because they are healthy, they cannot be affected and this is also a belief that affects use of new behaviors.

Perceived Benefits

This refers to the usefulness a behavior will have in helping the individuals reduce their susceptibility and severity of a health condition. When people are introduced to a new behavior that may help to keep them safe, their adoption of the behavior will depend on the benefits they perceive. Hence, people will make use of health services when they know the kind of benefits they can get from them. People will usually assess a disease and the possible outcomes against what they may get from the recommended behavior and when the benefits outweigh the consequences, they are more likely to change behavior. For a health official, there is the need to make people aware of all the benefits associated with a new action.

Perceived Barriers

People also tend to look at the barriers that may prevent them from adopting the new recommended behavior. When someone analyzes his/her condition and determines that there are no perceived barriers, then change of behavior easily occurs. Perceived barriers may include financial constraints in which case a person may lack the money needed for a new behavior. When people are advised to do something, they will have perceptions of things that may prevent them and for a health official, your duty is to help in identifying and getting rid of them.  A new action may come with effects people may not want and this also creates a barrier. Reducing barriers is the best way to get people doing using a new action. Glanz and Maddock (2002) assert that barriers are used in decision making where people consider the advantages and disadvantages of an action.

Cues to Action

Cues to action is a like something that reminds people of the new behavior they need to adopt or something that motivates them towards it. These can be used as a way of making people more aware of the need at the same time letting them know how to go about it. Cues to action strategies can do well in influencing the kind of behavior change required from people. Here, various media can be used and these include posters, radio, TV where you can remind people of the kind of danger they are facing if they will not take up a recommended action. Safety instructions on many products that can easily affect health are a good example of cues to action as it reminds people of what they should be doing or avoiding.

Other Variables

Other variables include characteristics that may be unique to an individual but are also influential in forming perceptions. These include such things as education level which may place one in a position to know everything about a condition as compared to one who knows less. Similarly, cultural and demographic differences may also bring about the difference in perception in which case someone they may have different views about a behavior. The belief that people who live in certain areas are susceptible to some kind of diseases may make other people not to take a disease seriously.  People experiences, especially ones related to a disease will also result in their different perceptions since someone may consider it serious while the other may take it lightly.

Self-Efficacy

Bandura (1977) introduces self-efficacy as one’s own belief to do something. With self-efficacy, people have to believe that they can take the required action so to succeed otherwise, a barrier is created. When people have the fear of not being able to do the new action correctly, it hinders them from getting the intended benefits. Thus, you can only evoke behavior change in your subjects if you make them confident enough to believe they can perform. Rosenstock, Stretcher and Becker (1998) insist that the focus of the health belief model should also be on the individual’s confidence. This is because it was found to have an influence on the kind of choices people make regarding recommended actions. Self-efficacy can be improved through a variety of strategies but it works well of you take time to show people what they ought to be doing to prevent them from shying away.

Implications for Health Behaviors

Many health researchers have applied the health belief model in several studies to determine how people behave towards diseases and practices and these can  portray well the implication of the model to health behavior. Glanz and Maddock (2002) say that there are many factors that might affect health behaviors apart from policies and regulations. Breast-self examination is one of them and for this; early detection is always the best. However not many of the women are keen on conducting breast self examinations and in their study, Norman and Brian (n. d) found that breast self examination performance was affected by several independent predictors which included intention, perceived benefits and self-efficacy.

Hanson and Benedict (2006) use the model in their study to establish food handling behaviors among the older adults. Thus, health belief model is also applicable in nutrition where it can be used to find out how safe people are handling their food. One of the things Hanson and Benedict’s study established is that sanitation was prompted by the perceived severity people had of foodborne illnesses. This is just one of the things that people will use to take action, for instance, when they see on posters or other media of how an illness may affect them, they may have that perception of its severity and would therefore conform to cleanliness.

Radius and Joffe (1988) sought to focus their use of the model on young mothers or adolescents and their perception of breastfeeding.  This is because they may be presented with barriers arising from their own beliefs about activity. These are also benefits and together with the barriers help to influence the young mothers’ decision on whether to breastfeed or not. Radius and Joffe found that many of the adolescent mothers perceived fewer barriers to breastfeeding which shows that many of them found the method to be better than bottle feeding. Many times, people tend to have the wrong information about something which creates the perceived barriers.

While the health belief model can be used on women regarding changing behavior on breast self examination, it can also be used to study the perceptions men have on prostate cancer.  Kleier (2004) conducted such a study on Jamaican and Haitian men where she also sought to find out how much they knew about the illness. In comparing the two Kleier found that Jamaican men seemed to have more information as compared to Haitian men. The study also established that there are other variables affecting perceptions which include language and culture with regard to the subjects of the study. Here, many of the Haitian men have language problems which not made it difficult for them to acquire the relevant knowledge about the disease.

Health belief model does not just have an effect on patient behavior but the staff also has perceptions that can be studied. This is the focus of Agarwal, Sypher and Dutta’s (2009) study where they chose to find the effect of selected constructs of the model on staff behavior. The researchers used knowledge, perceived effectiveness and cues to action and found, among other things, that greater knowledge contributed to a low perception of benefits but did not affect barriers or behaviors. Gatewood et al. (2008) seek to find out how perceived barriers and self-efficacy affect the attendance of a community health program, specifically for cardiovascular risk reduction. They established that participants who had not been exposed to the program tended to have more perceived barriers as compared to those who know about the program.

Roden (2004) used of the model for the promotion of health practices among young families. The researcher used perceived behavioral control and behavioral intention for the study where the model could be modified to suit the selected group. It was established that the two were suited for the modified model. Cerkoney and Hart (1980) used the model to explain behavior of people with diabetes mellitus with regard to how well they complied with their treatment. It was found that there are procedures that they seemed to take seriously with which many of them were complaint while there are those they seemed to ignore.

The use of cues to action is a common practice in health field when there is a need to sensitive people on an issue. Marifran (1999) examines the role HIV test counselors can play in persuading people to play safe sex. The study found that such cues to action improved the condition and many people tended to play safe. Winfield and Whaley (2002) chose to use the model to study the use of condoms where they focused on African American college students. The study found out that condom use was determined by perceived barriers and gender.

Behavior change

Recognition and labeling of one’s behavior

Behavior change is best effected when an individual is able to recognize that he/she exhibits bad behavior which needs to be changed. Here, one would need to know what kind of behavior is questionable and to realize that one can easily be affected by such behavior. In their study Marcus et. al (1992) established that people could adopt more to exercising by understanding the stages of exercise behavior and self-efficacy through the necessary information.

Making a commitment to change behavior

The second step is to make a decision to reduce or do away with the behavior that has been identified as bad. Here, one may have to look at both the advantages and disadvantages as well as how the change may affect you. Since behavior change is to help reduce the risks involved, you may also want to analyze what kind of response you may get once you become the person of desirable qualities. Just like in the health relief model, self-efficacy involves a person determining whether he/she is able to take that action that would lead to behavior change. With this, it may be worthwhile for an individual to consider what will be needed in order to make the process successful. This is in terms of being able to perform the activities chosen and the willingness to keep on trying in case of failure.

Taking action the third action

The third action to behavior change is to take action and this is where an individual may have to consider things such as level of self esteem and communication abilities. This stage may occur in three phases but are not a must and may be skipped. In phases, an individual would be required to seek information first that would be useful to the situation. This is the stage that one needs to have good communication skills as well so you can explain to people that you have changed and the reasons. The individual is exposed to a number of choices with regard to whether formal or informal help is required. There may also be need to have certain resources to help in the adoption of a desired behavior which is also identified at this stage of behavior change model.

Stages of Change

Stages of Change Theory identify some stages which are to be considered during the behavior change cycle. This model is useful in a number of instances where behavior change is necessary and Kern (2008) says that behavior change with this model is a series of steps where individuals will go through different stages before successful change can be realized. Usually, someone will move to the next stage when he/she has established that it is appropriate to proceed and this is only after completing the previous stage.

The developers of this theory advance the four stages which are pre-contemplation, contemplation, action and maintenance and there is also a fifth stage which is the preparation for action.  Prochaska, DiClemente and Norcross (1992) provide a description for each of the stages involved in the cycle. Each of the stages involve an individual doing a different activity, from the initial stages where the person is still considering whether to decide to change or not to the end when he/she either maintains the new behavior or relapses.

Pre contemplation

This is the initial stage which Kern (2008) says that people here are not serious and may not even be interested in getting help. This is where they are still trying to come to terms with the bad side of their behavior and it may take some time to convince them that they ought to get rid of their current behavior. In this stage, the individual needs to be given a lot of information which will help in understanding their bad habits. There is also need to let the people know what environmental effect their behavior is causing.

Contemplation

At this stage, people have started to take more interest and can therefore accept that they have a behavior problem. This may be prompted by several factors which include experiencing someone suffering as a result of the behavior but this generally involves a self evaluation. Zimmerman, Olsen and Bosworth (2000) say that this is a stage where a patient examines benefits and costs involved and may be helped by incorporating other models such as health belief model.

Preparation for Action

This is where the decision has already been made regarding behavior change and the individual is making plans to take necessary action. When the person understands and can see how serious their bad habits are, he/she would start finding the help needed. This may involve the person finding as much information as possible about the situation and the possible solutions that could be of help.

The action stage is where the person has already selected a course of action such as a behavior change and is not practicing it. This may not be very easy since it may involve a complete change of behavior and since one may have been used to the bad habits very much, there are chances of relapsing. Kern (2008) says that this is people may take different amount of times at this stage but may last up to 6 months.

Maintenance

At the maintenance stage, the person is trying not to relapse and move back to the old habits. When you are in the action stage, it only takes a while before you enter into the maintenance stage provided you are consistent. Those who are able to prevent relapse tend to benefit more from the benefits that change in behavior was meant to bring. The amount of time here is indefinite and will depend on how well a person is able to adapt to new behavior without chances of going back.

Studies that used the Health Belief Model

Attia, A. K., Rahman, D. A., & Kamel, L. I. (1997). Effect of an educational film on the Health

Belief Model and breast self-examination practice. Eastern Mediterranean Health Journal .   Volume 3, Issue 3, 1997, Page 435-443.Page 435-443

Cerkoney, K. A., & Hart, L.K. (1980). The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes Care, September 1980 vol. 3 no. 5 594-598 doi: 10.2337/diacare.3.5.594.

Gatewood, Jadah Sataje &  George Munroe. (2008). Perceived barriers to community-basedhealth promotion program  participation. American Journal of Health Behavior , May-June, 2008. Retrieved 13 th March, 2010 from <http://findarticles.com/p/articles/mi_7414/is_3_32/ai_n32056841/>

Hanson, J. A. & Benedict, J. A.  (2002). Use of the health belief model to examine older adults’food-handling behaviors. Journal of Nutrition Education and Behavior. Volume 34, Supplement 1, March-April 2002, Pages S25-S30. Retrieved 14 th March, 2010 from http://dx.doi.org/10.1016/S1499-4046%2806%2960308-4

Kleier, J, A. (2004). Using the health belief model to reveal the perceptions of Jamaican and

Haitian men regarding prostate cancer. Journal of Multicultural Nursing & Health , Fall 2004. Retrieved 29 th March, 2010 from http://findarticles.com/p/articles/mi_qa3919/is_200410/ai_n9459581/

Mackey, J. A. (2002). Using a health belief model in teaching preventive health care principles to Israeli RNs. A paper for presentation at the CITA Conference University of Massachusetts Lowell November 7, 8, 9, 2002 .

Norman, P., & Brian, K. (n. d) . Health belief model and breast self-examination: An application of the health belief model to the prediction of breast self-examination in a national sample of women with a family history of breast cancer. Institute of Medical Genetics

University of Wales College of Medicine, UK. Radius, S.M., & Joffe, A. (1988). Understanding adolescent mothers’ feelings about breast-feeding : A study of perceived benefits and barriers. Journal of Adolescent Health Care Volume 9, Issue 2, March 1988, Pages 156-160. doi:10.1016/0197-0070(88)90063-0

Roden J. (2004). Validating the revised Health Belief Model for young families: implications for nurses’ health promotion practice. Nurs Health Sci . 2004 Dec; 6(4):247-59.

Winfield, E. B., & Whaley, A. L. (2002). A comprehensive test of the health belief model in the prediction of condom use among African American college students. Journal of Black Psychology , Vol. 28, No. 4, 330-346

Agarwal, V., Sypher, H. E. and Dutta, M. J. (2009). Health belief model in healthcare settings: knowledge, perceived effectiveness, and cues to action on staff behaviors.  Paper presented at the annual meeting of the International Communication Association, Marriott, Chicago, IL Online <PDF>. Retrieved 19 th March 2010 from http://www.allacademic.com/meta/p300001_index.html

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review , 84, 191-215.

Gatewood, J.  G. et al. (2008). Perceived barriers to community-based health promotion program participation. American Journal of Health Behavior , Retrieved  29 th March, 2010 from <http://findarticles.com/p/articles/mi_7414/is_3_32/ai_n32056841/>

Glanz, K., & Maddock, J. (2002). Behavior, Health-Related. Encyclopedia of Public Health. Retrieved 29 th March, 2010 from< http://www.encyclopedia.com/topic/Health_behavior.aspx>

Hanson, J. A. & Benedict, J. A.  (2002). Use of the health belief model to examine older adults’ food-handling behaviors. Journal of Nutrition Education and Behavior. Volume 34, Supplement 1, March-April 2002, Pages S25-S30. Retrieved 14 th March 2010 from http://dx.doi.org/10.1016/S1499-4046%2806%2960308-4

Hochbaum, G. M. (1958). Public Participation in medical screening programs: A socio-psychological study. ( Public Health Service Publication No. 572 ). Washington, DC: Government Printing Office.

Kern, M. F. (2008). Stages of change model. AddctionInfo.org . retrieved 29 th March 2010 from <http://www.addictioninfo.org/articles/11/1/Stages-of-Change-Model/Page1.html>

Kleier, J, A. (2004). Using the health belief model to reveal the perceptions of Jamaican and Haitian men regarding prostate cancer. Journal of Multicultural Nursing & Health , Fall 2004. Retrieved 29 th March, 2010 from http://findarticles.com/p/articles/mi_qa3919/is_200410/ai_n9459581/

Mackey, J. A. (2002). Using a health belief model in teaching preventive health care principles to Israeli RNs. A paper for presentation at the CITA Conference University of Massachusetts Lowell November 7, 8, 9, 2002

Marcus, B. H et al. (1992) Self-efficacy and the stages of exercise behavior change. To insert individual citation into a bibliography in a word-processor, select your preferred citation style below and drag-and-drop it into the document.   Res Q Exerc  Sport , Vol. 63, No. 1. (March 1992), pp. 60-66.

Marifran, M. (1999). Toward a reconceptualization of communication cues to action in the health belief model: HIV test counseling. Communication Monographs , 1479-5787, Volume 66, Issue 3, 1999, Pages 240 – 265

Norman, P., & Brian, K. (n. d) . Health belief model and breast self-examination: An application  of the health belief model to the prediction of breast self-examination in a national sample of women with a family history of breast cancer . Institute of Medical Genetics University of Wales College of Medicine, UK.

Prochaska, J.O., DiClemente, C.C. and Norcross, J.C. (1992). In search of how people change – applications to addictive behaviors. American Psychologist , 47(9), 1102-1114.

Radius, S.M., & Joffe, A. (1988). Understanding adolescent mothers’ feelings about breast- feeding : A study of perceived benefits and barriers. Journal of Adolescent Health Care Volume 9, Issue 2, March 1988, Pages 156-160. Retrieved 20 th March, 2010 fromhttp://dx.doi.org/10.1016/0197-0070%2888%2990063-0

Rosenstock I., Strecher, V., & Becker, M. (1994). The health belief model and HIV risk behavior change. In R.J. DiClemente, and J.L. Peterson (Eds.), Preventing AIDS: theories and methods of behavioral interventions New York: Plenum Press; pp. 5-24.

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

Zimmerman, G. L., Olsen, C. G., & Bosworth , M. F.(2000). A ‘Stages of Change’ approach to helping patients change behavior. American Family Physician (12), p.4.

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• Health Belief Model Essays

Health Belief Model Essays (Examples)

Filter by keywords:(add comma between each), example essays.

Health Belief Model in Application

Health Behavior Model: I would find that this examination would be best served by the values of the health belief model. This is an appropriate way to gain a better understanding of what causes people to make certain health behavior decisions, such as those which are likely to incline individuals who have previously refrained from physical activity for so long to make serious and immediate lifestyle changes. It seems reasonable to deduce that a perspective through this model might help to reveal such possible causes for a sedentary lifestyle as scheduling demands, physical injuries or a personal aversion to physical activity. The use of the health belief model should contribute…...

mla Works Cited MRN. (2005). Exercise in Moderation Best for the Brain. News-Medical. Online at   http://www.news-medical.net/?id=14724 . Nies, Mary A. (2006). Comparison of 3 Interventions To Increase Walking

Health Belief Model

Critical Analysis of a Research Article Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model Statement of the Phenomenon of Interest The phenomenon of interest is the health belief between patients and spouses after a cardiac event, which has been clearly stated to the reader by the researchers. There have been fewer qualitative comparisons of this kind conducted. The researchers used a qualitative method for this research because the study was exploratory and they had to collect data by examining and describing the health beliefs of…...

mla References Köhler, A. K., Nilsson, S., Jaarsma, T., & Tingström, P. (2017). Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event–a qualitative analysis based on the Health Belief Model. Scandinavian journal of caring sciences, 31(2), 332-341. Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.

Health Belief Model During the 1950's the

Health belief model During the 1950's, the Health Belief model (HB) was developed from the field of social psychology. The theoretical framework offers an explanation of why individuals are motivated to participate in preventive health behaviors. The model has five perception constructs of susceptibility, severity, benefits, barriers, and cues to action. In this setting the HB predicts what prevention behaviors diabetic patients will engage in to avoid foot pathology and ultimately amputation. Current research indicates that the Health Belief odel (HB) is the most common model used to study health- related behaviors. According to Ganz, Rimer, and Lewis (2002) an…...

mla Mahmoodi, A., Kohan, M., Azar, F., Solhi, M., & Rahimi, E. (2011). The impact of education using Health Belief Model on awareness and attitude of male teachers regarding their participation in family planning. Journal of Jahrom University of Medical Sciences, 9(3), 45-49. Smith, T.W. (2009). If We Build It, Will They Come? The Health Belief Model and Mental Health Care Utilization. Clinical Psychology: Science & Practice, 16(4) 445-448. Polit DF, Beck CT. (2007). Nursing research: Principles and methods. 7th ed. Philadelphia:

Health Belief Model Hbm Becker

ET or CT believes that the two key determinants of behavior are perceived self-efficacy and outcome expectancies. In other words, the extent to which the person feels able to actualize / implement behavior, and the consequences (both negative and positive) of performing the behavior. CT is actually an extension of ET in that it maintains that the environmental factors as well as human factors are all intertwined in determining self-efficacy; in fact that the three concepts play one inseparable whole in determining health conduct and response to prevention or to reaction of disease. The three main factors that induce a…...

mla Sources Sutton, S. (2002) Health behavior: Psychosocial theories. Retrieved on 1/13/2011from   http://userpage.fu-berlin.de/~schuez/folien/Sutton.pdf  National Cancer Institute. (2005). Theory at a glance: A guide for health promotion practice. U.S. Department of Health and Human Services.

Application of Health Belief Model to Treatment of Hispanic Youth Patients

Nursing - Applying Health Belief Model to Alcoholism Treatment and Implication for Healthcare Delivery Perceived susceptibility "Perceived susceptibility" is the patient's subjective perception of his/her risk of contracting an illness or disease, which would be alcoholism in the instant case There is significant disparity individual perceptions of personal susceptibility an illness or disease (Glanz, Rimer, & Viswanath, 2008, p. 48). Application of this key concept to treatment of Hispanic youth patients using or addicted to alcohol may consist of: discerning the populations at risk of becoming alcoholic and their risk levels for alcoholism; personalizing the risk based on an individual patient's characteristics…...

mla Works Cited Center on Alcohol Marketing and Youth. (2005, October 26). Exposure of Hispanic youth to alcohol advertising, 2003-2004. Retrieved from www.camy.org:   http://www.camy.org/_docs/resources/reports/archived-reports/hispanic-youth-03-04-full-report.pdf  Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice, 4th Edition . San Francisco: John Wiley & Sons, Inc.

Synthesizing Transculture Theory and the Health Belief Model Theory

Leininger's Transcultural Theory and the Health Belief Model: A Synthetic Approach to the Problem of Geriatric Care Geriatric care is a challenge in most Es today because this is where geriatrics expect to receive regular treatment. Making this challenge all the more difficult is the fact that the U.S. population is aging and diversifying. The CDC has reported that over the next 15 years, the U.S. elderly population will consist of more non-Hispanic whites, Asians and non-Hispanic blacks than ever before. Considering that at the same time geriatrics will make up 20% of the population, it is especially important to know…...

mla References Carpenter, C. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25(8): 661-669. Che, S., Barrett, E., Velez, M., Conn, K., Heinert, S., Qiu, X. (2014). Using the Health

The Health Belief Model Theoretical Application Assignment

THEOETICAL APPLICATION 8Theoretical Application AssignmentPart One: The Health Belief Model and HPV Vaccination Uptake among Young AdultsCervical cancer is a fundamental health concern for nations globally. The World Health Organization (WHO) recommends the human papillomavirus (HPV) vaccine as an effective way to prevent HPV-related conditions, including cervical cancer (Alsulami et al., 2023). The vaccine is available for young children aged between 9 and 12, although young adults aged between 13 and 26 could also receive a catch-up immunization if they did not begin or complete the vaccination series before age 12 (Alsulami et al., 2023). According to Kamolratanakul and Pitisuttithum…...

mla ReferencesAlsulami, F., Sanchez, J., Rabionet, S., Popovici, L., & Baraka, M. A. (2023). Predictor of HPV vaccine uptake among foreign-born college students in the US: An exploration of the role of acculturation and the health belief model. Vaccines, 11(2), 422. DOI. 10.3390/vaccines11020422Boston University (2022). The Theory of planned behavior. Boston University.  https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/BehavioralChangeTheories3.html Calderon-Mora, J., Ferdous, T., & Shokar, N. (2020). HPV vaccine beliefs and correlates of uptake among Hispanic women and their children on the US-Mexico border. Cancer Control, 27(1), 1-9. DOI. 10.1177/1073274820968881Donadiki, E. M., Jimenez,-Garcia, R., Hernandez-Barrera, V., Sourtzi, P., Carrasco-Garrido, P., Andres, A., Jimenez-Trujillo, I., & Velonakis, E. G. (2014). Health belief model applied to non-compliance with HPV vaccine among female university students. Public Health, 128(3), 268-273. DOI. 10.1016/j.puhe.2013.12.004 Kamolratanakul, S., & Pitisuttithum, P. (2021). Human papillomavirus vaccine efficacy and effectiveness against cancer. Vaccines, 9(12), 1413. DOI. 10.3390/vaccines9121413 Sabouri, M., Shakibazadeh, E., Mohebbi, B., Tol, A., Yaseri, M., & Babaee, S. (2020). Effectiveness of an educational intervention using theory of planned behavior on healthcare empowerment among married reproductive-age women: A randomized controlled trial. Journal of Education and Health Promotion, 9(1), 1-8.

Health Beliefs and Behaviors

Health Belief Model: Weight Management with African-American WomenThe health belief model (HBM) is based upon the concept of changing a subjects beliefs to motivate change in his or her behavior. Critical components of the model include perceived severity, perceived susceptibility, perceived barriers, perceived benefits, self-efficacy, and cues to action (Martinez et al., 2016, p.3). For example, when healthcare providers convince patients that a behavior such as overeating and subsequent weight gain can have a severe impact upon health and when patients understand their susceptibility to these health consequences, patients are more apt to view losing weight as desirable. When patients…...

mla ReferencesArd, J. D., Zunker, C., Qu, H., Cox, T., Wingo, B., Jefferson, W., & Shewchuk, R. (2013). Cultural perceptions of weight in African American and Caucasian women. American Journal of Health Behavior, 37(1), 313.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106677/pdf/nihms603623.pdf  Martinez, D. J., Turner, M. M., Pratt-Chapman, M., Kashima, K., Hargreaves, M. K., Dignan, M. B., & Hbert, J. R. (2016). The effect of changes in health beliefs Among African-American and rural white church congregants enrolled in an obesity intervention: A qualitative evaluation.Journal of Community Health,41(3), 518525.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844792/pdf/nihms740897.pdf Saghafi-AslM, AliasgharzadehS, Asghari-JafarabadiM (2021)Correction: Factors influencing weight management behavior among college students: An application of the Health Belief Model. PLOS ONE 16(5):  https://doi.org/10.1371/journal.pone.0252258

Health Promotion Health Belief

Osteoporosis and the Health Belief Model Discuss the Health Belief Model The Health Belief Model was initially a systematic mode of predicating and thus preventing health behavior. By focusing on the relationship between the practices and the behaviors of health services it aimed to create a theoretical presentation of the same. Later it was revised to motivate the general health for the 'purpose of distinguishing illness and sick-role behavior from health behavior'. [Brown, 1999] The HBM is essentially a concept that integrates psychological motivators with physical and social settings. Its said to have been initiated in 1952 by three socio-psychologists, Godfrey Hochbaum,…...

mla References Brown, Kelli M. [January 11, 1999] HEALTH BELIEF MODEL Community and Family Health University of South Florida Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavior change. Psychological Review, 84, 191-215.

Obesity Prevention Using Health Belief

S Gubbels. Talks about how obesity is a major problem of our society and how it is affecting the children and adults. The article talks about the causes and the consequences of obesity and provides certain prevention for this problem. The article relates the problem of obesity with the Health Belief Model and talks about how the Model contributes in motiving the people to bring Health behavior change in their lives. It point out the reasons for people in bringing behavior changes associated with the Health Belief Model. (J.S Gubbels, 2013) In the article "Health Belief Model in the Town of…...

mla References Baranowski, T. (2012, September 6). Obesity. Are Curent Health Behavior Change Models Helpful in Guiding Prevention of Weight Gain Efforts. Boskey, E. (2010, 24 March). Sexually Transmitted Diseases. Health Belief Model.

Primary Health Care Initiative

Health Care -- PHI A Primary Health Care Initiative (PHI) is a fundamental, affordable health care mode clearly illustrated the Declaration of Alma-Ata. Michelle Obama's "Let's Move!" adheres to the PHI format and uses the Health Belief Model as its guide. Unfortunately, several problems with both the Model and the initiative hamper its success. Several measures can be taken to significantly enhance the initiative's impact. Identify PHI (20%) A PHI is a fundamental and affordable mode of health care that is grounded in realistic, well-established and culturally agreeable science and practices, and is made accessible to all members of a community (HO, 1978,…...

mla Works Cited Clarke, V.A., Lovegrove, H., Williams, A., & Machperson, M. (2000). Unrealistic optimism and the health belief model. Journal of Behavioral Medicine, 23(4), 367-376. Keating Simons, K. (2010, December 13). Let's Move: Looking at the flaws of a childhood obesity intervention. Retrieved November 8, 2013 from   Web site: http://challengingdogma-fall2010.blogspot.com 

Public Health Models and SDOH in Childhood Obesity

Health Belief Model and Health Education Public/population health standards place the conventional medical individual care model within several determinants of health. Currently, various public health models exist and are available for a huge range of purposes such as the Health Belief Model. These various health models exist to provide an improved understanding of the dynamics relating to the health and wellbeing of populations. In addition, there are social determinants of health (SDOH), which basically refer to the political, social and economic factors that impact the health of individuals and populations. The social determinants of health also refer to the ecological model…...

Health of Indigenous Australian Using Ecological and

Health of Indigenous Australian Using Ecological and Holistic Health Paradigm Patterns of health and illness Physical Health Mental Health Spiritual Health Social Health Impact of Broader Environments Natural Built Social Economic Political Critical eflection Health is a basic component of human life that comprises of multiple facets. The description of health has witnessed dramatic change during past few years, as it has become a holistic phenomenon. Previously, it was considered that a healthy person is the one who does not suffer from any ailment or illness. However in recent times, the physical, psychological and communal aspects of human life have been amalgamated to give a broader perspective to human health which is identical…...

mla References Australian Institute of Health and Welfare 2012, Australia's health 2012, AIHW, Australia. Biddle, N & Yap, M 2010, Demographic and Socioeconomic Outcomes Across the Indigenous Australian Lifecourse: Evidence from the 2006 Census, ANU E. Press, Australia.

Health Promotion Theory Description and

Pender's is a theory of preventive medicine, for the healthy rather than the chronically ill. However, in an age where lifestyle-related disease are on the rise, it can provide an important function, particularly for nurses facing an epidemic of pre-diabetic and diabetic adolescents reared on poor diets and little physical activity. Some might protest that the genetic component to even Type II Diabetes, or obesity in general, might be unacknowledged in the model, but Pender would no doubt respond to her critics that although it is true that certain individuals have a greater predisposition to certain lifestyle diseases, everyone…...

mla Works Cited McEwen & Willis. (2007). "Chinn & Kramer Model." From Chapter 5 of Theoretical bases for nursing. Pender, Nola J. (2003). "Most frequently asked questions about the Health Promotion

Health Maintenance Organization Impact on

" (AAF, nd) The Health Maintenance Organization further should "…negotiate with both public and private payers for adequate reimbursement or direct payment to cover the expenses of interpreter services so that they can establish services without burdening physicians…" and the private industry should be "…engaged by medical organizations, including the AAF, and patient advocacy groups to consider innovative ways to provide interpreter services to both employees and the medically underserved." (AAF, nd) One example of the community healthcare organization is the CCO model is reported as a community cancer screening center model and is stated to be an effective mechanism for facilitating…...

mla Principles for Improving Cultural Proficiency and Care to Minority and Medically-Underserved Communities (Position Paper) (2008) AAFP -- American Academy of Family Physicians   http://www.aafp.org/online/en/home/policy/policies/p/princcultuproficcare.html  Volpp, Kevin G.M. (2004) The Effect of Increases in HMO Penetration and Changes in Payer Mix on In-Hospital Mortality and Treatment Patterns for Acute Myocardial Infarction" The American Journal of Managed Care. 30 June 2004. Issue 10 Number 7 Part 2. Onlineavaialble at:   http://www.ajmc.com/issue/managed-care/2004/2004-07-vol10-n7Pt2/Jul04-1816p505-512  Darby, Roland B. (2008) Managed Care: Sacruificing Your Health Care for Insurance Industry Profits: Questions You must ask before joning an HMO. Online available at: http://www.rolanddarby.com/br_managedhealth.html

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• Form a Team: Tool 1
• Assess Organizational Health Literacy and Create an Improvement Plan: Tool 2
• Primary Care Health Literacy Assessment
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Culture—including customs, beliefs, and values—can influence how people understand health concepts, how they take care of their health, and how they receive medical advice and make health decisions. People can be part of more than one culture, based on their racial, ethnic, religious, political, gender, or sexual identity, as well as their age, family composition, what language they speak, where they were born, where they live, what their occupation is, and other factors. Clinicians can learn to develop treatment plans with patients that are consistent with and respectful of their cultures.

Here are some examples of how culture can influence how your patients interact with you.

Health beliefs: In some cultures, people believe that talking about a possible poor health outcome will cause that outcome to occur.

Family customs: In some cultures, family members play a large role in healthcare decision making. Healing customs: Traditional healers and herbal or other remedies can augment or substitute for Western medicine in some cultures.

Religious beliefs: Religious, faith, or spiritual beliefs may affect healthcare-seeking behavior and people's willingness to accept specific treatments or behavior changes.

Dietary customs: Disease-related dietary advice will be difficult to follow if it does not conform to the foods or cooking methods used by the patient.

Interpersonal customs: Eye contact or physical touch will be expected in some cultures and inappropriate or offensive in others.

Learn from patients.

• "I would like to be respectful—what do you like to be called and what pronouns do you use?"
• "Tell me about things that are important to you. What should I know that would help us work together on your health?"
• "Lots of people visit providers outside the clinic. Who else do you visit about your health?"
• "Tell me about the foods you eat at home so we can develop a plan together to help you reach your goal of losing weight."
• "Your condition is very serious. Some people like to know everything that is going on with their illness, whereas others may want to know what is most important but not necessarily all the details. How much do you want to know? Is there anyone else you would like me to talk to about your condition?"
• "What do you call your problem? What do you think caused it? How do you think it should be treated?"
• Do not stereotype. Understand that each person is an individual and may or may not adhere to certain cultural beliefs or practices common in his or her culture. Do not make assumptions based on group affiliations or how people look or sound. Asking patients themselves is the best way to be sure you know how their culture may impact their care.

Learn from other sources.

High-quality online resources provide education on how to provide culturally appropriate services.

• Think Cultural Health offers several courses for free continuing education credit, as well as fact sheets on ways to improve care for diverse populations.
• The Centers for Disease Control and Prevention (CDC) offers free continuing education credit for Effective Communication for Healthcare Teams: Addressing Health Literacy, Limited English Proficiency and Cultural Differences .
• The National LGBTQIA+ Health Education Center offers educational programs, toolkits, training videos, and over 50 webinars that provide continuing education credit.
• EthnoMed contains information about cultural beliefs, medical issues, and other related issues pertinent to the healthcare of recent immigrants.
• Invite a member of a relevant cultural group to attend a staff meeting and share observations about how their culture may impact healthcare.
• Invite an expert to conduct an inservice training to educate staff on how to deliver culturally appropriate services.
• Build ongoing relationships with leaders in the community who can serve as cultural brokers.
• Integrate cross-cultural skills into orientation and other trainings. In addition to training dedicated to improving cross-cultural skills, you can weave those skills into all training activities.

Remember that culture is not limited to religious, racial, or ethnic groups. For example, the Deaf and LGBTQI+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, and others) communities have distinct cultures.

Help staff learn from each other.

To increase understanding about cultural diversity:

• Hire clinical and other staff who reflect the demographics of your patient population. They can help contribute to creating a comfortable environment for patients and can share insights with others in the practice regarding the customs of their cultural groups.
• Have staff take cross-cultural skills trainings and set aside time for them to share what they learned.

Practice cultural humility.

• Reflect on your own values, beliefs, and cultural heritage; how that affects your personal health practices; and how you interact with the healthcare system.
• Analyze the ways the dominant and medical cultures shape how your practice delivers healthcare and consider changes to make it more inclusive of the patient populations you serve.
• Do not make assumptions. You cannot tell a person’s race, ethnicity, gender, or other cultural identities by looking at them. Treat everyone as an individual and ask people to tell you about themselves.
• Being humble and respectful. 
• Recognizing patients’ expertise about themselves and what they want for their health.
• Adopting a more open, less authoritarian style. 
• Commit to being a lifelong learner who values diversity and seeks to make healthcare more equitable.

Track Your Progress

Before implementing this Tool, count the number of staff members who have completed a cultural competence training session. Repeat after 2, 6, and 12 months.

On a regular basis, randomly select some medical records and see what percentage have notes on the patient's culture, customs, or health beliefs.

Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions . 

Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.

Internet Citation: Consider Culture: Tool 10. Content last reviewed February 2024. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

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Using the Health Belief Model to Explain the Patient's Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

Angelina alphonce joho.

a School of Nursing and Public Health, Department of Clinical Nursing, University of Dodoma, Tanzania

Background:

Hypertension remains a public-health challenge globally. Its prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. This study is guided by the Health Belief Model (HBM) to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam, Tanzania.

An analytical cross-sectional study was conducted in 3 region hospitals in Dar es Salaam from April to May 2012. The study included patients who were on antihypertensive medications. Simple Random Sampling was used to enrol the study participants. Data was collected using structured questionnaire. Data was analysed using SPSS version 20. Linear Multiple Regression analysis was performed to identify variables which are strongest predictor of treatment compliance among variables of the Health belief Model.

A total of 135 participants were enrolled of whom 56% were compliant to hypertensive treatment. Multivariate analysis indicated significant model fit for the data (F=11.19 and P value < .001 ). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R 2 =0.303) with perceived barrier being the strongest predictor of treatment compliance (β=−0.477; p < .001 ). Other predictor variables were not statistically associated with treatment compliance.

Conclusion:

The study showed that 56% of study participants had hypertensive treatment compliance and perceived barrier to treatment was the strongest predictor. Innovative strategy on improving patients’ perception of barrier to treatment is recommended in order to improve treatment compliance.

Hypertension remains a public-health challenge globally. It is the main modifiable independent risk factor for development of cardiovascular disease, stroke and renal failure which increase significantly with age 1 . Prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. 2 Control and prevention of hypertension complications can only happen when individuals recognise the benefits of changing lifestyle behaviour and believe that they are susceptible to hypertension complications. 3

Health Belief Model (HBM) has been used to explain and predict individuals health behaviours for preventing and/or controlling diseases and their complications by including perception of susceptibility, seriousness, severity, benefits and barriers to a health behaviour and cues to action. 3 The global burden of hypertension projects indicate that the number of adults with hypertension will increase by 60% to a total of 1.56 billion in 2025. 4 For Sub-Saharan Africa, the prevalence of hypertension has been projected to be 125.5 million among adults in 2025. 5

In Tanzania, hypertension related diseases are the second cause of hospital admission and cause of deaths. 6

Tanzania particularly in the cities like Dar es Salaam, people are experiencing urbanisation and modernisation. This has brought about changes in their lifestyle especially their diet intake and physical activity. This has led to overweight, obesity and physical inactivity which altogether increase the risk for hypertension and cardiovascular diseases. 7 , 8

Management of hypertension requires medication and lifestyle compliance. The lifestyle modification includes; increase in exercise, lowering of body mass index, reduced-sodium diet, moderation of alcohol consumption and quitting smoking. 9 These lifestyle modifications and taking medication properly are examples of therapeutic behaviours. 9 The treatment guideline of hypertension in Tanzania are either nonpharmacological or pharmacological treatment. Nonpharmacological treatment calls for life style modification which includes weight reduction, adopting dietary approaches to stop hypertension (DASH) such as eating diet rich in fibre-fruits, vegetable, unrefined carbohydrate and low-fat dairy products with reduced content of saturated and total fat. Also, reduction in dietary sodium intake, involvement in regular physical activity such as a brisk walking for at least 30 min/day 3 days a week, stop the use of all tobacco products and reducing alcohol consumption. 10 Pharmacological treatment includes combination of drugs including diuretics, Angiotensin-Converting Enzyme Inhibitor (ACEI), Angiotensin Receptor Blocker-ARB, Beta-blocker and Calcium Channel Blocker. 10

Uncontrolled hypertension is caused mainly by non-adherence to the antihypertensive drugs 11 and lifestyle. 12 Understanding drug regimens by the patients helps to improve their adherence, and thus preventing the complications related to hypertension which are debilitating and if not prevented may increase the burden of cardiovascular diseases. 12 Adhering to antihypertensive drugs remains to be an important modifiable factor towards management of hypertension. Non adherence to anti-hypertensive agents seriously affect the effectiveness of treatment and thus causing an increase in cardiovascular and cerebro vascular risks and consequently causing population health problems in the quality of life as well as health economics. Non-adherence to pharmaceutical therapy is a major problem all over the world. Studies on drug adherence to chronic diseases such as hypertension show that adherence is about 67.2%. 11

HBM is an approach that is used to describe social behaviour as well as individual's cognition. It was introduced in the 1950s by Social psychologists so as to facilitate in reasoning individual's participation in health programs such as health check-ups and immunisation. 14 The HBM was also widely used to explain a range of health behaviour. The model also base on studying compliances with lifestyle modification and antihypertensive medication, including understanding that high blood pressure involves both drug treatment and lifestyle changes.

According to Rosenstock et al, the HBM constructs reported were perceived susceptibility, perceived severity, perceived barriers, perceived benefits and cues to action hypothesises that health-related action depends upon an individual's motivation, belief of being vulnerable to a disease and one's belief to certain health recommendations that is important in befitting health and reduce disease complications. 15 ( Figure 1 ).

Inter-relationship between Variables of Health Belief Model which were used to explain Hypertension Treatment Compliance

Little is documented on the influence of health belief model variable on compliance to hypertensive treatments. Therefore, this study aimed at assessing the influence of Health Belief Model variable on hypertensive treatment compliance among hypertension patients in 3region Hospitals in Dar es Salaam, Tanzania.

Study Design and Setting

We conducted an analytical cross-sectional study design from April to May 2012 using quantitative approach. The study included data from 3 regional hospitals in Dar es Salaam; Amana, Mwananyamala and Temeke hospitals which are located in Ilala, Kinondoni and Temeke Municipalities respectively. The estimated population in these municipalities is 1,220,611, 1,775,049 and 1,368,881 people for Ilala, Kinondoni and Temeke Municipalities respectively. 16 The study sites were selected because majority of hypertensive patients who are diagnosed from primary health facilities are referred to those hospitals for expert management.

Study Population

The study population included patients with hypertension who were using antihypertensive treatment and were attending hypertension clinics from the selected hospitals. Each Hospital has 2 days per week of clinic for non-communicable diseases including hypertension. All 3 hospitals have inpatient and outpatient services.

Sample Size and Sampling Procedure Sample Size

Sample size of 135 participants was calculated using kish and Leslie formula (1965).

The prevalence used was 34% compliance in Temeke-Dar es Salaam. 17

Where: n = the required minimum sample size

ε = margin of error (5%)

p = estimated proportion of compliance 34%

z = standard normal deviate corresponding to 95% confidence level=1.96

Considering a margin error of 5% and a 95% confidence level, the minimum required sample size obtained was 135.

Sampling Procedure

The 3 regional hospitals were selected purposively because most of the patient who have hypertension and hypertensive complications are referred to these hospitals from the Primary Health Facilities. We reviewed the records of hypertensive patients attending in each of the 3 hospitals for the period of 1 month. We found that 366, 583 and 340 patients attended Amana hospital, Mwanayamala hospital, and Temeka hospital respectively. The 135-sample size calculated was proportionally allocated to 3 hospitals based on the above records. Thus, 39 participants were selected from Amana, 60 from Mwananyamala and 36 from Temeke hospital. Simple random sampling was used to select the study participants. The researcher established a sampling list from patients attending hypertensive clinics to the respective study hospitals to obtain eligible participants that meet the inclusion criteria. There were pieces of paper that were written on; YES or NO. The word “YES” was used to represent the targeted study population, and “NO” was used to represent the population that was not going to participate in the study. The procedure of drawing papers from the box by each study participant was used. Once apiece of paper was picked, it was not included in the sample again and each participant was allowed to pick only once.

The Inclusion Criteria and Exclusion Criteria

All patients aged 18 years and above with a diagnosis of hypertension for at least one month with or without other co-existing medical conditions and consented to participate in the study. Participants who had been taking anti-hypertensive treatment for at least one month before the beginning of the study were included. Allpatients who had not started antihypertensive treatment and could not respond because of reasons such as being too sick to be interviewed were excluded from the study.

Measures of Outcome

The outcome variable was treatment compliance which comprised of medication regimen compliance and lifestyle modification. Medication regimen compliance was composed of 8 items, asking “how often you forget to take your medicine”. The responses were measured on a 4-point Likert scale: “1” Every day, “2” frequently, “3” rarely or “4” never. For life style, compliance was having 5 items, participants were asked to respond to the single question based on a 4-point Likert scale: “How often do desirable or undesirable behaviours related to control of hypertension”. The responses were: “1” Every day, “2” frequently, “3” rarely or “4” never. Some questions were set such that the highest score did not reflect the worst scenario of non-compliance. To resolve these, scores were reversed. For example, how often do you engage in physical exercise “4”, every day, “3” frequently, “2” rarely or “1” never. The 13 items measuring treatment compliance and life style compliance were added up to get sum index with a distribution ranging from 33 to 52 with mean 44.2963 (SD =3.32578), the median split was used (44.4), which was dichotomised into two groups i.e. 0 = those who are non-treatment compliant and 1 = treatment compliant which was 34–43 and 44–51.

The HBM constructs included perceived severity of having hypertension, perceived susceptibility of being at risk of hypertension complications and perceived benefit were each was measured by 6 items. The reminders (cues to action) were measured by 7 items. Participants were then asked to respond: “1” strongly agree, “2” agree, “3” disagree or “4” strongly disagree.

6 items measuring perceived severity were added up to get sum index with a distribution ranging from 7 to 24 with mean 20.10 (SD =2.85). The median split 50.4 was used as a cut-off point. Dichotomisation was done into 2 frequency groups; those who had low perceived severity and those who had high perceived severity. 6 items measuring perceived susceptibility were added up to get sum index ranging from 6 to 19 with mean of 10.79 (SD =2.83). The median split was 49.6. The sum index for perceived susceptibility was dichotomised into 1= those with low perceived susceptibility and 2= those with high perceived susceptibility.

6 items measuring perceived benefit were added up to get sum index with a distribution ranging from 12 to 24 with mean (SD) 20.24(2.87) and median split 51.1. Then dichotomised into; those with low perceived benefit and those with high perceived benefit. 7 items measuring cues to action were added up to get sum index with a distribution ranging from 15 to 28 with mean (SD) 24.27(2.65) median split 42.2, then dichotomised into 2 frequency groups; those with low perceived cues to action and those with high cues to action.

5 items measuring perceived barriers were added up to get sum index with a distribution ranging from 5 to 15 with mean (SD) 8.36 (2.48), median split 54.8, then dichotomised into; those with low perceived barrier and those with high perceived barrier. The aspects that might hinder respondents to comply with their treatment included not having enough time to do exercise. Responses were “1” strongly not a problem, “2” not a problem, “3” problem and “4” strongly a problem.

Bivariate analysis using Chi-squire and Pearson correlation between HBM variables were performed. Multiple linear regression analysis was performed with treatment compliance as the outcome variable (behaviour) and the rest of HBM variables as predictors of the behaviour.

Data Analysis

Data was analysed using SPSS software programme 17.0 version. The chi-square test was used to compare proportions. Multivariate analysis was performed using Linear Multiple Regression to obtain strongest predictor variable between variables of HBM. A p-value less than 0.05 was considered statistically significant.

Ethical Approval

Muhimbili University of Health and Allied Sciences (MUHAS) approved the study (Ref. NO. MU/PGS/SAEC/Vol. VI). All participants gave their written consent to participate and were informed that they could terminate their participation at any time without incurring any cost.

A total of 135 participants were included in the study. The mean age of participants was 56.3, ±13.1 years. Most of the participants 76 (56.3%) were females aged between 33 to 84 years. Majority of participants 82 (60.7%) were married. With respect to education level, most of the participants 74 (54.8%) had primary education. Regarding occupation, most of the participants 75 (55.6%) were unemployed ( Table 1 ).

Socio-Demographic Characteristics of Respondents N=135

Factors Associated with Treatment Compliance

The association between socio-demographic factors and treatment compliance was explored. Treatment compliance was significantly associated with sex. Female participants had higher proportion of treatment compliance (63%) than males (46%) (P=.044). Participants with less than 64 years of age 50 (56.8%) had higher proportion of treatment compliance than participants with 65 and above years (53.2%) p=.686. Participants with secondary education had 10 (62.5) compliance compared to those with informal education 25 (55.6%). However, the difference was not statistically significant ( Table 2 ).

Relationship between Social Demographic Characteristics and Treatment Compliance

Association of Health Belief Model Variables with Treatment Compliance

Participants with high perceived severity were more compliant 39(57.4%) to hypertension treatment compared to those with low perceived severity who had only 36(53.7%) complaint to hypertensive treatment. However, the difference was not significant ( p=.672 ). Those with high perceived susceptibility to hypertension complications were more compliant 45(66.2%) to hypertensive treatment compared to those with low perceived susceptibility, who had complaint of 30(57.4%) only and the difference was significant ( p=.012 ). Participants with high perceived benefit of using antihypertensive treatment were more complaint 44(66.7%) to hypertensive treatment compared to those with low perceived benefit 31(44.9%) and the difference was significant (p=.011). Regarding perceived barrier, those with low perceived barrier were more complaint 57(77%) to treatment compared to those with high perceived barrier to hypertensive treatment (18(29.5), the difference was significant ( p=.000 ). Regarding cues to action, those who had high remainders were more complaint 52(66.7%) to treatment compared to those with low remainders of using hypertensive treatment 23(40.4%) and difference was significant (p=.002 ) ( Table 3 ).

Association of Health Belief Model Constructs with Treatment Compliance

Health Belief Model Factors Predicting Treatment Compliance

Treatment compliance showed significant positive association with perceived benefit (r=0.27; P=.001 ) which means the higher the perceived benefit of using medicine the higher the treatment compliance. Treatment compliance showed significant negative association with perceived barrier to treatment (r=−0.53; P=.000 ), indicating that the higher the perceived barrier the lower the compliance. Treatment compliance showed positive association with cues to action (r=0.19; P=.022 ) which means that when people receive more reminders of the importance of adhering with treatment, they become more compliant.

Perceived severity of hypertension showed significant positive association with perceived susceptibility of getting hypertension complications (r=0.29; p=.001 ) indicating that the higher the perceived severity of hypertension disease the higher the perception of being vulnerable to hypertension complications. Perceived severity showed positive significant association with cues to action (r=0.2; p=.019 ) indicating that the higher the perception of severity of hypertension the higher the following of the cues to action (reminders). Perceived benefit of using medication showed significant negative association with perceived barrier (r=−0.45; p=.000), this meant that the higher the perception of benefit the lower the perception of barriers.

Also perceived benefit of using medication showed positive association with cues to action (r=0.32; p=.000), meaningthat the higher the perception of benefit the higher the perception of following reminders ( Table 4 ).

Correlation of Health Belief Model Variables with Treatment Compliance

Health Belief Model Factors Associated with Treatment Compliance

Multivariate analysis indicated significant model fit for the data (F=11.19 and P value=.000). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R 2 =0.303) with perceived barrier being the strongest predictor of treatment compliance (β=−0.477; P=.000). A negative Beta Coefficient indicates a negative association between perceived barriers and treatment compliance. Other predictor variables were not statistically associated with treatment compliance ( Table 5 ).

R 2 = 0.303; F = 11.19 ( P = .000 )

Behaviour = Compliance to treatment.

This study explored factors affecting treatment compliance among hypertensive patients who were attending hypertension clinics in Dar es Salaam. This study was guided by Health Belief Model. The key findings in this study include positive association between age, sex, level of education, marital status and treatment compliance. We also found that the significant predictors of using HBM constructs were perceived susceptibility of being at risk of getting hypertension complications, perceived benefit of using medicine, perceived barrier to treatment and cues to action. After control of all factor variables among the construct of the HMB, the strongest predictor was perceived barrier.

The study revealed the percentage of treatment compliance to be 55.6% among study participants. Similarly, Imad et al reported that 55.9% of hypertension patients had good adherence to antihypertensive medication. 18 The compliance rate of 55.6% in the present study was low compared to the findings in the study conducted by Okello et al in Uganda and Adidja et al in Cameroon in which the compliance rate was 85% and 67.7%, respectively. 19 , 20

Our findings showed that compliance to antihypertensive was higher than that of the study conducted by Pallangyo et al in tertiary hospitals in Tanzania which reported that 25.3% were compliant to their hypertensive treatment. 21 Study conducted by Bovet et al in Temeke Dar es Salaam, reported low (34%) adherence of patients to antihypertensive treatment. 17 Similar to a study by Goweda and Shatla. 22 The possible reason for the discrepancy observed in treatment compliance could be explained by the nature and type of hospitals included in our study. Our study considered hypertensive patients with no other complications while the study conducted by Pallangyo et al involved admitted patients with heart failure as a complication of uncontrolled hypertension. 21 .

The current study shows that; participants who were 64 and below years of age had higher level of treatment compliance compared to those with 65 and above. The results are comparable to those reported in the study conducted by Demoner et al in the city of Maringá and Choi et al in Korea which reported that young age group showed association with treatment compliance and older patients showed poor adherence to antihypertensive treatment. 23 , 24 The possible explanation of these results may be that young people have higher income since they are able to work and thus can afford to buy medications when compared to older people. Another possible reason is that older people are more likely to have more than one disease due to aging which may have exposed them to using multiple drugs and in turn they become frustrated and, hence, stop taking drugs. 25 Also cognitive and functional impairment in elderly patients increase their risk of poor drug compliance, thus they may require to have someone to remind, support and assist them in taking their drugs. 26

Our study results revealed that female patients were more compliant to antihypertensive medication (63.2%) compared to male patients ( P=0.044 ). Female patients have been reported to be better at adhering to antihypertensive treatment as compared to male patients. 27 , 28

Impotence is the likelihood side effect which affects men's compliance with antihypertensive medications. This could be the reason why males showed low level of treatment compliance compared to females. 28 , 29 The findings from the current study revealed that patients with secondary level of education had a higher level of treatment compliance to antihypertensive medications as compared to those with informal education (62.5 vs 37.5%). However, the difference was not significant. The probable reason could be that patients with high education level are likely to be more complaint to antihypertensive medications, due to the fact that having high education level make an individual to think critically about hypertension complications and also to have informed decision making about use of antihypertensive medications. 30 This is similar to the study done by Saruna at el who reported that the level of education was significantly associated with treatment compliance. 30 The same was reported by Yan et al in the study conducted in China. 28 Also, Goweda and Shatla reported that patients with high level of education might be adherent to antihypertensive medication and life style modification since they understand the adverse effect of not being complaint to medication. 22

The association between marital status and treatment compliance was revealed, in the current study, married participants were more compliant to medications (61%) when compared to single participants. Abbas et al also found that divorce was associated with poor adherence to antihypertensive medication (OR=2.14, 95% CI=1.31–5.48). 31 Marriage might have a positive effect on compliance to medications. Partners might help each other in reminding each other the time for taking medications and also give moral support on the importance of treatment.

Perceived barrier was an important predictor in non-compliance to antihypertensive drugs and physical exercises.

This finding agreed with the study conducted by Yang et al in rural area of China which reported that adherence to antihypertensive medications is higher with less perceived barriers 32 a scale based on the HBM, and the four-item Morisky Medication Adherence Scale. Results 745 hypertensive patients participated in the study (345 men, 400 women. The perceived barrier to antihypertensive medication was also reported by Obirikorang et al in the study conducted in Ghana. 33 This is true according to the Health Belief Model: when a person perceives there is an obstacle of taking medication, he will not comply to his medication and exercise as supposed to and this will lead to complications and/or death.

Barriers of not complying with antihypertensive medication were determined. The reasons were; stopping medication due to cost of the medications 20 , 34 , fear of the side effect 35 , 36 , feeling well (asymptomatic) 37 , avoiding addiction to drugs 38 , 39 and use of traditional medicine. 28

This study reported compliance to antihypertensive treatment of (55.6%) among study participants. Perceived barrier to treatment of hypertension was the strongest predictor among the constructs of HBM. Patients need advice, support and information from health professionals in order to understand the importance of using drugs as prescribed.

It is recommended that health care providers should be aware that hypertensive patients need to be educated on how to manage the disease and also be reminded continuously for better control of hypertension and improving the quality of their lives. This education and reminders should focus on the importance of complying to antihypertensive medications, physical exercises, diet and salt intake restriction. However, the HBM variables do not provide for advising patients the importance of treatment adherence, thus there is a need to use more than one theoretical model to provide adherence to antihypertensive advice to patients. Further studies should be conducted to assess why people have perceived barriers to treatment compliance.

Limitation of the study

This study was conducted in Tanzania government regional hospitals in 3 Municipals of the Dar es Salaam region only. A cross sectional study design was used. Therefore, results cannot be generalised to all hypertension patients in Dar es Salaam because of the nature of the study design. Self-reporting of treatment compliance could introduce recall bias by either over reporting or under reporting depending on the patient's behaviour in the recent past. Based on the reason that this was a cross-sectional study, there is a possibility of recall bias in our study. In the current study HBM, remain descriptive and does not suggest the action for patients to change their behaviour. HBM should be used with other models so that patients can be advised to change their behaviours.

Acknowledgement

I would like to acknowledge the late Dr Seblda Leshabari for her guidance and analytical advice during proposal and manuscript writing. May her soul rest in eternal peace.

Funding Statement

Funding: This study did not receive any funding

Peer Reviewed

Competing Interests: None declared.

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Essay Culture Health Beliefs

Why are Culture Health Beliefs so Important in a Health Care Setting? Why are Culture Beliefs so Important in a Health Care Setting? There are many cultures out in the world today that practice beliefs different than those in the United States. America is based off Western Culture and traditional medicine practices which focus on preventative and curative medicine. Most cultures around the world practice folk medicine, which focus more on the person as a whole with remedies and ceremonies rather than medicine and treatment. Even though each one believes in a different practice, all medical professionals should have the knowledge and awareness of each culture’s health beliefs to properly treat their patients in a respectful and kind …show more content…

Adapted from Culture Clues, University of Washington Medical Center (2004), American Indians and Alaskan Natives believe that the head and hair are sacred and touching either is very personal and disrespectful. Symbolic items like hair, jewelry, or ornaments need to be kept close to the patient at all times because they have spiritual meaning. A second culture that a medical professional should be aware of is the Vietnamese, handshakes are appropriate between men not women (Culture Clues, 2001). They also believe that the head is the most sacred part of the body, so avoid touching it unless necessary. To show respect to the patient someone would avoid direct eye contact and bow the head because it shows that the individual is not being disrespected (Giger and Davidhizas, 2008). The patient’s norms are always something to remember so the beliefs are not offended. By having awareness on beliefs it will also help to get a grasp on what the religion traditions in healing. When understanding the many beliefs that cultures have, helps grasp an understanding the healing practices a family may have. In today’s society, “religious practices are usually rooted in culture” (Giger and Davidhizas, 2008). Typically each culture has a set of beliefs that they use to explain their health and manners that prevent or treat illnesses and diseases. When a family member is ill, a culture uses rituals to get rid of the disease.

Native American Healing Traditions Could Supplement Modern Western Medicine

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Health belief model

Health Belief Model (HBM) is just one out of many psychological models that help predict and explain health behaviors, and use these behaviors to address negative health conditions. Perceived susceptibility, perceived seriousness of the condition, perceived benefits of an action, and perceived barriers to action form the basic set of HBM indicators. The preliminary analysis indicates that the female patient will be able to lose 30 pounds and to reduce the barriers to further weight loss.

Introduction

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Numerous psychological approaches are used to raise the effectiveness of health promotion. Health Belief Model (HBM) is just one out of many psychological models that help predict and explain health behaviors, and use these behaviors to address negative health conditions. Universal character, convenience, and cost-effectiveness of psychological models in health promotion have already turned HBM into a valid tool for exploring and changing a wide range of long and short-term health behaviors.

Theoretical background

Health Belief Model was the first psychological model that was trying to predict health behaviors and to use those predictions to address negative health conditions. Rosenstock (1974) and Becker (1974) have adopted a new set of measurements to evaluate the individual’s chances for becoming healthier, and to develop a set of valid measures that would effectively deal with health issues and their complications. Original researches provide substantial empirical support for using HBM in health promotion (Becker, 1974; Janz & Becker, 1984; Rosenstock, 1974); prospective studies and retrospective researches prove that HBM creates extremely favorable conditions for dealing with complex health issues. “In the context of a prospective experimental design, a psychosocial approach to understanding individual health-related actions (the Health Belief Model) is evaluated in terms of its ability to predict and explain adherence to the diet”, but the diet is not the only health condition where HBM can be useful (Janz, Champion & Stretcher, 2002). Founded on attempts to integrate cognitive theory with stimulus-response theory, HBM can be effectively applied to a wide variety of health conditions. The discussed psychological model targets person’s desire to minimize negative health consequences; it further develops the patient’s confidence that the recommended set of actions will help achieve the desired condition (Becker, 1974). “Reinforcements and incentives do not influence action directly, but via influencing the person’s valuation of the action and the judgment of the likelihood that it will produce results” (Rosenstock, Stretcher & Marshall, 1988).

Perceived susceptibility, perceived seriousness of the condition, perceived benefits of an action, and perceived barriers to action form the basic set of HBM indicators. These indicators are used to assess patient’s preparedness towards undertaking the recommended set of health-related actions. The results of preliminary health analysis provide health professionals with valuable information which further determines the cues to action and the level of individual’s self efficacy (Janz & Becker, 1984).

In his original research, Rosenstock (1974) evaluated the validity and limitations of HBM as applied to various health conditions: the research has found significant “support to the importance of several of the variables in the model, as explanatory or predictive variables. However, a seventh major investigation conflicted in most respects with the findings of the earlier studies”; as a result, HBM was also effectively applied to predict voluntary behaviors in essentially healthy people. One significant limitation of HBM was reported by Janz & Becker (1984): the authors concluded that “interventions that incorporated the HBM precepts tended to produce superior results, but it was often impossible from the studies to isolate the effects of the HBM from other characteristics of the intervention”.

The object of the analysis is a young female facing weight loss issues. During the last three months, the woman has gained 25 extra pounds. The reasons of weight gain include heavy job duty, stress, and chronic fatigue. The patient realizes the importance of physical exercises, and knows that excess weight is the recipe for major health issues. The task is to develop a set of effective procedures that will address weight loss issues using HBM principles.

The success of HBM implementation will be based on the evaluation of the three essential components: whether the woman is confident that her health problem (excess weight) can be avoided; whether she is confident that the recommended set of actions (diet and exercise) will address her negative health condition; and whether she is prepared to undertake the recommended course of actions to achieve the anticipated positive results (i.e., weight loss).

The analysis of perceived susceptibility suggests that the patient realizes the risks of her negative health condition. The analysis of perceived severity indicates the patient’s awareness about the seriousness of excessive weight issues and the possible complications it may cause to her health. Generally, patients with the mildest forms of obesity have the lowest levels of perceived susceptibility, but in the present case, the person is fully prepared to undertake the set of recommended actions to lose excess weight (30 pounds). The level of perceived benefits is so high, that health providers do not need to develop the patient’s belief that exercises will help achieve the predetermined health goals. It is critical that the patient is prepared to the constructive dialogue with the health provider and possesses objective opinion about the benefits of physical exercise. However, the patient displays the increasing level of perceived barriers, among which heavy workload, stresses, and fatigue prevail. Here, the role of healthcare provider is to provide motivating guidance and to re-consider the reasons of heavy workload and constant fatigue that prevent the patient from participating in recommended course of health promotion activities.

Recommendations

It is recommended that the patient participates in the physical therapy group. The group facilitator will provide the patient with the necessary guidance and will monitor the patient’s progress. The patient is recommended to undertake a six-week physical therapy course; full information about possible barriers, complications, and problems will be delivered to the patient at the beginning of the course. The patient displays readiness to reduce the barriers against effective weight loss, and is likely to stay with the group until the very end of the course. The patient will be able to evaluate other group members’ progress; those with the best weight loss indicators will serve the role models and will further motivate the patient towards attending physical therapy sessions. Simultaneously, the healthcare provider will need to address other related health issues, to identify the reasons of excessive fatigue, and to decrease its impact on physical therapy outcomes.

Independent and dependent variables

Perceived susceptibility, perceived severity, perceived benefits, and barriers form a set of independent variables that will impact the effectiveness of physical exercise on the weight loss (dependent variable). The actual severity of the patient’s health condition is the intervening variable that indicates the link between the perceived severity and the weight loss during the physical therapy course. The success of other group members represents a different set of variables that impact the patient’s psychological condition and her preparedness to stay with the group until the very end of the course.

It is very probable that in the course of implementing HBM to reduce excess weight in a female patient, we will not be able to distinguish the effects of HBM principles from those of other medical interventions. However, HBM forms a sound practical framework that determines the patient’s chances to achieve the predetermined health goals, and shows the means for increasing these chances (i.e., making the patient aware, prepared, and active). The recommended course will involve a number of independent variables that will impact the outcomes of the physical therapy course, but the preliminary analysis indicates that the female patient will be able to lose 30 pounds and reduce the barriers to further weight loss.

• Becker, M.H. (1974). The health belief model and personal health behavior. Health
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• Janz, N. & Becker, M.H. (1984). The Health Belief Model: A Decade Later. Health
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• Janz, N.K., Champion, V.L., & Stretcher, V.J. (2002). The Health Belief Model. In K. Glanz,
• B.K. Rimer, & F.M. Lewis (eds), Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass.
• Rosenstock, I.M. (1974). Historical origins of the Health Belief Model. Health Education
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• Rosenstock, I.M., Stretcher, V.J., & Marshall, H.B. (1988). Social learning theory and the
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What Research Says About Being a Stay-at-Home Parent

Ask people what they think about  stay-at-home moms  (SAHMs) and stay-at-home parents in general, and you'll likely get a variety of answers. Some might say they've got it easy, or that life at home with the kids would be boring. Some might think they're lazy or not contributing much to society. Others contend that stay-at-home parents are making the best decision of their lives and that they're making a noble, worthwhile sacrifice to stay home and nurture their kids day in and day out.

If you're contemplating whether or not to be a stay-at-home parent, what matters most is what works best for your family. So, first and foremost, consider your personal beliefs, priorities, finances, and lifestyle. However, there is also a wealth of research on the subject that you can consult when making your decision. The findings on life as a stay-at-home parent may surprise you.

Brianna Gilmartin

Pros and Cons of Staying at Home

There are, of course, many personal reasons for or against staying home with your kids. Benefits may include more opportunities for quality time with your children and having more direction over their learning and development. You may not want to miss a minute of their childhoods. You also might not trust others to care for your little loves. Drawbacks include the big hit to your family's income and the trajectory of your career as well as the big change to your lifestyle.

While there is no right or wrong answer, this research may help inform your choice. Remember that each of these benefits and drawbacks may or may not apply to you. There are many different factors, such as budget, lifestyle, priorities, social support, relationship status, spousal involvement, and your kids' specific needs, to consider before making your final decision.

Evidence-Based Benefits of Being a Stay-At-Home-Parent

There are many reasons that parents choose to stay at home with their children. Studies have shown that many people think this is the best option for kids when financially plausible. According to a Pew Research Center study, about 18% of American parents stayed home with their children in 2021.

According to Pew Research Center's Social and Demographic Trends, 60% of Americans say a child is better off with at least one parent at home. While 35% of responders said that kids are just as well off with both parents working outside the home.

Benefits for Children of Stay-at-Home-Parents

A 2014 study found that the benefits of having a parent at home extend beyond the early years of a child's life. The study measured the educational performance of 68,000 children. Researchers found an increase in school performance to high school-aged children. However, the biggest educational impact was on kids ages 6 and 7.

Most  homeschooled students  also have an at-home parent instructing them. A compilation of studies provided by the National Home Education Research Institute supports the benefits of a parent at home for educational reasons. Some research has found homeschoolers generally score 15 to 30 percentile points above public school students on standardized tests and achieve above-average scores on the ACT and SATs.

Regardless of whether parents stay home or work outside the home, research shows that parent involvement in schools makes a difference in children's academic performance and how long they stay in school.  Some kids with learning differences and/or special needs may do better in a school (vs. homeschooling) to access any required services .

Decreased Stress and Aggression in Kids

Some studies link childcare with increased behavioral problems and suggest that being at home with your children offers benefits to their development compared with them being in  being in childcare  full-time.  This may be reassuring news for stay-at-home parents knee-deep in diapers and temper tantrums.

Studies have found that children who spend a large amount of their day in daycare experience high stress levels, particularly at times of transition, like drop-off and pick-up.

Subsequent studies also showed higher levels of stress in children in childcare settings compared with those who are cared for at home. But that doesn't mean you have to keep your children with you every minute until they're ready to go to school. Look for a nanny or babysitting co-op that allows your kids to play with others while giving you some time alone.

Greater Control of Children's Upbringing

The ability to directly protect, spend time with, and nurture their children each day is often cited as a primary benefit of not working outside the home. Studies show that some parents stay home specifically to have greater first-hand control over the influences their child is exposed to. Others simply see it as their duty to be the one who provides daily care to their little ones.

More Parents Want to Stay Home

According to the Pew Research Center, more people are becoming stay-at-home parents—and 60% of Americans believe that choice is best for children. The number of stay-at-home parents jumped from a low of 23% in 1999 to 29% in less than 15 years. However, today's rates don't match those of the 1970s and earlier when around 50% of women (and very few men) were stay-at-home parents.

While the number of men taking on this role is far lower than that of women (around 210,000 compared with over 5.2 million), the rate of men becoming stay-at-home dads is on an upswing, too. Between 2010 and 2014, the prevalence of men choosing to stay home increased by 37%.

Downsides of Being a Stay-at-Home Parent

Regardless of the increasing numbers and some important benefits, a decision to quit your job to become a stay-at-home parent shouldn't be made out of guilt or peer pressure. While there are many great reasons to be a stay-at-home parent, it's not necessarily right or beneficial (or financially plausible) for everyone. For some families, the drawbacks significantly outweigh any positives.

Some People Miss Working

Research shows that many stay-at-home parents miss working outside the home and think about  going back to work  someday.  It can be tough to leave behind the tangible rewards and results of a job, especially one you enjoyed and were good at.

If you stay home when your kids are little but plan to return to the workforce, you can take some steps to bridge that employment gap, such as taking classes, earning licenses or certificates that enhance your resume, or even taking a part-time job.  You might also consider at-home business opportunities as well as  remote jobs  that let you stay home while also earning money and reclaiming some of what you missed about your career.

Costs to Your Career and Wallet

The decision to stay at home with your kids means giving up income. Research shows that stay-at-home parents must contend with lost wages now and decreased wages when returning to work. This "wage penalty" often amounts to 40% less in earned income over time.

There is also a big hit to the stay-at-home parent's career trajectory. Some parents can regain their previous work roles upon reentering the workforce, while others struggle to get a foothold professionally after taking time off.

The direct impact on your family's finances will depend on your personal earning potential, skills, and career choices—as well as the income of your partner if you have one. However, studies show that mothers who reenter work after having children experience between a 5% and 10% pay gap compared with their childless peers. This is in addition to the gender pay gap.

Adverse Impacts on Physical and Mental Health

Studies show that stay-at-home parents experience poorer physical and mental health compared with parents who work outside the home. Effects include higher rates of mental health conditions, such as depression and anxiety, as well as higher rates of chronic illness. A 2012 Gallup poll surveyed 60,000 women including women with no children, working moms, and stay-at-home moms who were or were not looking for work, and found more negative feelings among SAHMs. There are likely several reasons for this, including experiencing more parental and financial stress. Working parents tend to have access to more robust health insurance plans than stay-at-home parents. They also tend to benefit from greater self-worth, personal control over their life, economic security, and more dynamic socio-economic support.

However, it's worth noting that significant research shows that whether they work outside the home or not, parents generally are less happy than their childless counterparts.  Of course, the joy you get from parenting (and staying home with the kids) is likely to be highly individual.

More Social Isolation

A 2015 study found that many moms are spending lots of time with their kids, more so than in years past. Researchers believe this extra kid-focus results in a higher potential for social isolation. Interestingly, the research found no scientifically proven difference in outcomes for the children with this additional parental attention.

Some stay-at-home parents may feel isolated or undervalued by what some call the " mommy wars, " which pit parents against each other. This social dynamic can create perceived judgments or pressures that leave some stay-at-home parents feeling like they're not respected as worthy members of society. On the flip side, some working parents may feel criticized for not spending as much time with their children. Both groups can end up feeling socially isolated.

A 2021 study found that around a third of all parents experience loneliness. That's why it's so important for all parents (whether they stay at home or work outside the home) to find the right balance of social activities, exercise, sleep, hobbies, and self-care. Additionally, it's helpful to make the most of your family time, including  creating gadget-free zones  and planning fun activities you can all enjoy.

It's also key to take care of your own emotional well-being and let your children spend some time away from you. Whether it's a date night with your spouse or scheduling a day off so you can have some alone time, you're not going to shortchange your child because you didn't spend every minute with them. Giving yourself parenting breaks and opportunities to socialize is important for your well-being, particularly during times of stress.

Parenthood and well-being: A decade in review .  J Marriage Fam .

Stay at home moms and dads account for about 1-in-5 U.S. parents . Pew Research Center. 

After decades of decline, a rise in stay-at-home mothers . Pew Research Center. 

Home with mom: The effects of stay-at-home parents on children’s long-run educational outcomes .  J Labor Econ. 

National Home Education Research Institute.  Research facts on homeschooling .

Effect of parental involvement on children’s academic achievement in chile .  Front Psychol.  

School performance among children and adolescents during COVID-19 pandemic: A systematic review .  Children (Basel) .

The NICHD study of early child care and youth development . U.S. Department of Health and Human Services. 

Toddlers’ stress during transition to childcare .  European Early Childhood Education Research Journal .

Examining change in cortisol patterns during the 10-week transition to a new child-care setting .  Child Dev .

7 key findings about stay-at-home moms . Pew Research Center. 

The mother's perspective: Factors considered when choosing to enter a stay-at-home father and working mother relationship .  Am J Mens Health .

The relationships between mothers' work pathways and physical and mental health .  J Health Soc Behav .

The motherhood penalty at midlife: Long-term effects of children on women's careers .  J Marriage Fam .

Parents' work schedules and time spent with children .  Community Work Fam .

Gallup.  Stay-at-home moms report more depression, sadness, anger .

Parenthood and happiness: Effects of work-family reconciliation policies in 22 OECD countries .  AJS .

Does the amount of time mothers spend with children or adolescents matter? .  J Marriage Fam.

Experiencing loneliness in parenthood: A scoping review .  Perspect Public Health .

  First things first: Parent psychological flexibility and self-compassion during COVID-19.   Behav Anal Pract .

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Where Tim Walz Stands on the Issues

As governor of Minnesota, he has enacted policies to secure abortion protections, provide free meals for schoolchildren, allow recreational marijuana and set renewable energy goals.

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By Maggie Astor

• Aug. 6, 2024

Gov. Tim Walz of Minnesota, the newly announced running mate to Vice President Kamala Harris, has worked with his state’s Democratic-controlled Legislature to enact an ambitious agenda of liberal policies: free college tuition for low-income students, free meals for schoolchildren, legal recreational marijuana and protections for transgender people.

“You don’t win elections to bank political capital,” Mr. Walz wrote last year about his approach to governing. “You win elections to burn political capital and improve lives.”

Republicans have slammed these policies as big-government liberalism and accused Mr. Walz of taking a hard left turn since he represented a politically divided district in Congress years ago.

Here is an overview of where Mr. Walz stands on some key issues.

Mr. Walz signed a bill last year that guaranteed Minnesotans a “fundamental right to make autonomous decisions” about reproductive health care on issues such as abortion, contraception and fertility treatments.

Abortion was already protected by a Minnesota Supreme Court decision, but the new law guarded against a future court reversing that precedent as the U.S. Supreme Court did with Roe v. Wade, and Mr. Walz said this year that he was also open to an amendment to the state’s Constitution that would codify abortion rights.

Another bill he signed legally shields patients, and their medical providers, if they receive an abortion in Minnesota after traveling from a state where abortion is banned.

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