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History and Orientation
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. The model was developed in response to the failure of a free tuberculosis (TB) health screening program. Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.
Core Assumptions and Statements
The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person:
|1.||feels that a negative health condition (i.e., HIV) can be avoided,|
|2.||has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and|
|3.||believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence).|
The HBM was spelled out in terms of four constructs representing the perceived threat and net benefits: perceivedsusceptibility, perceived severity, perceived benefits, and perceived barriers. These concepts were proposed as accounting for people’s “readiness to act.” An added concept, cues to action, would activate that readiness and stimulate overt behavior. A recent addition to the HBM is the concept of self-efficacy, or one’s confidence in the ability to successfully perform an action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit the challenges of changing habitual unhealthy behaviors, such as being sedentary, smoking, or overeating.
Table from “Theory at a Glance: A Guide for Health Promotion Practice” (1997)
|Perceived Susceptibility||One’s opinion of chances of getting a condition||Define population(s) at risk, risk levels; personalize risk based on a person’s features or behavior; heighten perceived susceptibility if too low.|
|Perceived Severity||One’s opinion of how serious a condition and its consequences are||Specify consequences of the risk and the condition|
|Perceived Benefits||One’s belief in the efficacy of the advised action to reduce risk or seriousness of impact||Define action to take; how, where, when; clarify the positive effects to be expected.|
|Perceived Barriers||One’s opinion of the tangible and psychological costs of the advised action||Identify and reduce barriers through reassurance, incentives, assistance.|
|Cues to Action||Strategies to activate “readiness”||Provide how-to information, promote awareness, reminders.|
|Self-Efficacy||Confidence in one’s ability to take action||Provide training, guidance in performing action.|
Source: Glanz et al, 2002, p. 52
Scope and Application
The Health Belief Model has been applied to a broad range of health behaviors and subject populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer to compliance with recommended medical regimens, usually following professional diagnosis of illness. 3) Clinic use, which includes physician visits for a variety of reasons.
This is an example from two sexual health actions. (http://www.etr.org/recapp/theories/hbm/Resources.htm)
|Concept||Condom Use Education Example||STI Screening or HIV Testing|
|1. Perceived Susceptibility||Youth believe they can get STIs or HIV or create a pregnancy.||Youth believe they may have been exposed to STIs or HIV.|
|2. Perceived Severity||Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.||
Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid.
|3. Perceived Benefits||Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.||
Youth believe that the recommended action of getting tested for STIs and HIV would benefit them — possibly by allowing them to get early treatment or preventing them from infecting others.
|4. Perceived Barriers||
Youth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level).
Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options).
|5. Cues to Action||Youth receive reminder cues for action in the form of incentives (such as pencils with the printed message “no glove, no love”) or reminder messages (such as messages in the school newsletter).||
Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).
|6. Self-Efficacy||Youth confident in using a condom correctly in all circumstances.||
Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment).
Conner, M. & Norman, P. (1996). Predicting Health Behavior. Search and Practice with Social Cognition Models. Open University Press: Ballmore: Buckingham.
Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice.San Fransisco: Wiley & Sons.
Glanz, K., Marcus Lewis, F. & Rimer, B.K. (1997). Theory at a Glance: A Guide for Health Promotion Practice.National Institute of Health.
Eisen, M et.al. (1992). A Health Belief Model — Social Learning Theory Approach to Adolescents’ Fertility Control: Findings from a Controlled Field Trial. Health Education Quarterly. Vol. 19.
Rosenstock, I. (1974). Historical Origins of the Health Belief Model. Health Education Monographs. Vol. 2 No. 4.
Becker, M.H. The Health Belief Model and Personal Health Behavior. Health Education Monographs. Vol. 2 No. 4.
Champion, V.L. (1984). Instrument development for health belief model constructs, Advances in Nursing Science, 6, 73-85.
Becker, M.H.,Radius, S.M., & Rosenstock, I.M. (1978). Compliance with a medical regimen for asthma: a test of the health belief model, Public Health Reports, 93, 268-77.
See also Health Communication
NURSING DIAGNOSIS: Knowledge Deficit
- Lack of exposure/recall; information misinterpretation
- Unfamiliarity with information resources
- Questions; request for information, statement of misconception
- Inaccurate follow-through of instructions/development of preventable complications
- Verbalize understanding of disease process/prognosis, potential complications.
- Correlate symptoms with causative factors.
- Identify/initiate necessary lifestyle changes and participate in care.
NURSING DIAGNOSIS: Self-Esteem/Body Image disturbed
- Biophysical changes/altered physical appearance
- Uncertainty of prognosis, changes in role function
- Personal vulnerability
- Self-destructive behavior (alcohol-induced disease)
- Verbalization of change/restriction in lifestyle
- Fear of rejection or reaction by others
- Negative feelings about body/abilities
- Feelings of helplessness, hopelessness, or powerlessness
- Verbalize understanding of changes and acceptance of self in the present situation.
- Identify feelings and methods for coping with negative perception of self.
NURSING DIAGNOSIS: Injury, risk for [hemorrhage]
- Abnormal blood profile; altered clotting factors (decreased production of prothrombin, fibrinogen, and factors VIII, IX, and X; impaired vitamin Kabsorption; and release of thromboplastin)
- Portal hypertension, development of esophageal varices
- Maintain homestasis with absence of bleeding
- Demonstrate behaviors to reduce risk of bleeding.
NURSING DIAGNOSIS: Breathing Pattern, risk for ineffective
- Intra-abdominal fluid collection (ascites)
- Decreased lung expansion, accumulated secretions
- Decreased energy, fatigue
- Maintain effective respiratory pattern; be free of dyspnea and cyanosis, with ABGs and vital capacity within acceptable range.
NURSING DIAGNOSIS: Skin Integrity, risk for impaired
- Altered circulation/metabolic state
- Accumulation of bile salts in skin
- Poor skin turgor, skeletal prominence, presence of edema, ascites
- Maintain skin integrity.
- Identify individual risk factors and demonstrate behaviors/techniques to prevent skin breakdown.
NURSING DIAGNOSIS: Fluid Volume excess
- Compromised regulatory mechanism (e.g., syndrome of inappropriate antidiuretic hormone [SIADH], decreased plasma proteins, malnutrition)
- Excess sodium/fluid intake
- Edema, anasarca, weight gain
- Intake greater than output, oliguria, changes in urine specific gravity
- Dyspnea, adventitious breath sounds, pleural effusion
- BP changes, altered CVP
- JVD, positive hepatojugular reflex
- Altered electrolyte levels
- Change in mental status
- Demonstrate stabilized fluid volume, with balanced I&O, stable weight, vital signs within patient’s normal range, and absence of edema.
Nursing Diagnosis: Nutrition: imbalanced, less than body requirements
- Inadequate diet; inability to process/digest nutrients
- Anorexia, nausea/vomiting, indigestion, early satiety (ascites)
- Abnormal bowel function
- Weight loss
- Changes in bowel sounds and function
- Poor muscle tone/wasting
- Imbalances in nutritional studies
- Demonstrate progressive weight gain toward goal with patient-appropriate normalization of laboratory values.
- Experience no further signs of malnutrition.