Health Belief Model (HBM)

Write a literature review about ‘Theories of Health Behaviour’.

Epidemic levels of stress are raging through Australian universities with more than 70% students reported psychological stress where one in three contemplated suicide or self-harm (Bell, Rajendran & Theiler, 2012). Students need to get engaged in positive health behaviour to avoid illness and maintain good health. Health models or paradigms are used for explaining health and its relationship to stress management. Therefore, the essay discusses health models use to understand, explain health behaviour and guide strategies for stress management and promotion of health. ‘The health behaviour models help students to make healthy lifestyle choices reducing stress and promoting wellness.’

This model is a conceptual framework that is used to guide disease prevention and health promotion explaining the changes in health-related behaviour. This theory explains that health behaviour is predicted by four major factors: perceived susceptibility and perceived seriousness to health threat, barriers and benefits of undertaking health behaviour guiding actions (Orji, Vassileva & Mandryk, 2012). This model provide an approach to understand clearly cause of behaviour that is quite necessary for predicting change which in turn is necessary for influencing health behaviour. This model helps to know that health choices are based on an individual’s rational thought, but also habits, emotions, personal preference and social conditioning. Therefore, it is an eye-opener that is effective in social teaching methods in healthy habits. However, this model has certain limitations as it is limited to health risking behaviour. This model does not provide understanding of social, environmental and personal factors influencing health conditions as it does not take into account individual determinants, habitual behaviour that inform decision-making accepted to recommended actions (Skinner, Tiro & Champion, 2015). This model is descriptive rather than explanatory and does not provide a strategy to change health-related behaviours. For disease prevention, benefits, barriers and perceived susceptibility are consistently associated with desired health behaviour and for the most effective use; the model should integrate other models accounting for environmental context suggesting change (Maddux & Kleiman, 2012).

This model is a model of behaviour change that accesses the readiness of an individual to act to new health behaviour by providing strategies and changing processes guiding individual. This model focuses on an individual’s decision-making and intentional change operating on the assumption that behaviour is not changed decisively and quickly. Instead, behaviour change is a habitual and cyclic process having different constructs and behavioural theories to its five stages being most effective. As this model takes personal behaviour into consideration, it ignores social context and moreover, there is no set criteria for determining the person’s change stages or time needed for change or for how long an individual remain in stage. In addition, this model addresses individuals at various stages of decision-making process resulting in tailored interventions for motivating and in assessing current change stages and accounting for relapse in decision-making process (Prochaska, 2013).

Transtheoretical Model (TTM)

Both the models are aimed at protecting individuals from illness, predict, understand and affect health behaviours and ability to change. HBM is cognitively based focusing on mental processes pertaining to change in health behaviour and does not take emotional health component into consideration. On the other hand, TTM is concerned with behavioural aspects specifying readiness of an individual or attitudinal awareness stages towards health behaviour change. However, both models are focused on behaviour and self-efficacy, HBM focus on constructs promoting change and TTM emphasizes on belief stages and attitude antecedent in changing ability (Coulson et al., 2016).  

HBM focuses on self-efficacy and perceived risks; TTM focuses on readiness to receive. TTM uses experiences and stages of individuals into categories whereas value-based constructs are involved in HBM generally applied to interventions and TTM is applied to tailored interventions at individual level. TTM is based on readiness of individual and HBM concerned with individual beliefs and attitudes. Concisely, both the models focus on awareness and self-efficacy (Baldwin, 2013).

The models are used for understanding the health behaviour aiming to recognize the variables influencing behaviour of people and how a person is likely to get engaged in a particular behaviour. From the psychological perspective, health behaviour describes the actions that are associated with development, prevention or predisposing factors for any condition or particular disease. Categories of health behaviour including diet, physical activity, drug or alcohol consumption and medication compliance are assumed to be behaviours that are greatly linked to health outcomes that requires alterations or eradication of particular behaviours. These models further provide an understanding of how individual lifestyle impact health over life course. However, these models do not explain why people behave and have differing ways of articulation of behaviour across time, place, ethnicity or gender (Wu & Edmondson, 2017).

As discussed in the above section that stress is highly prevalent among university students, it is important to manage stress and promote health and wellbeing. The above discussed models can be applied for stress reduction, management and provide solutions to improve their health.

According to King et al., (2012) HBM can be employed to manage stress for explaining, predicting and influencing health behavior in college students. The components of HBM are applied to the study like perceived barriers, benefits and cues to action. Perceived benefits in stress management include listening to music, exercising or running and talking to someone. Perceived barriers in using techniques include lack of time in using techniques, got up in the moment and embarrassed to use techniques in private, lack of awareness and ways to use it. According to Rizer et al., (2016) perceived mindfulness practice benefits are positively related to meditation. Perceived stress is positively related to perceived severity and susceptibility to stress problems. Communication of perceived benefits of mindfulness practices opposed by stress-related problems and development of health promotion messages among college students encourage lifelong health benefits through mindfulness meditation. According to Bistricky et al., (2017) HBM components predicted variability in intention and promoting willingness for better health outcomes. HBM can be employed for greater SRT use and dissemination among college students.

Limitations of HBM and TTM

According to Rabalais, (2015) stress is related to behavior and thoughts that specifically focused on health. HBM aid psychologists by providing them information for reducing stress and irrational health beliefs related to negative health outcomes among 18-45 year old including college students. According to Bamber & Schneider, (2016) out of 40, 33 studies and 25 of 34 studies showed significant decrease in stress through mindfulness meditation practice. Out of 57 studies, 12 studies reported use of theoretical framework that crated attention, awareness and self-reflection in turn increasing the ability for regulation of emotional response and increase in learning capacity.

According to Horiuchi et al., (2010) TTM can be applied to behavior change through the processes of covert and overt activities that students used for facilitating forwards stage transition. Situation-specific confidence represented by self-efficacy helped to practice targeted behavior. TTM acted as framework for stress management, coping and perceived stress. Relationship between stages of change for stress management and perceived stress management as well as coping was measured provided convincing results. Korean students in action and maintenance stages in TTM were more frequentwhere tthey cope well with stressful situations as compared to first three stages. Students showed less perceived stress as compared to other stages. Stage of change for stress management is related to personal perceptions of one’s ability to manage stressful conditions. According to Evangelia & Spiridon, (2011) overwhelming stressful situations in undergraduate students can be described through TTM that is a model of behavior change for effective positive behavior change. The self-efficacy concept in TTM is used for stress management where decisional balance between pros and cons of adopting practices of stress management and processes of change for progressing to maintenance and action stages. During the stages of change, self-efficacy increases up to maintenance stage interplaying between pros and cons of stress management at stages of preparation and precontemplation as compared to other stages.

The subsequent studies evaluate the physical activity and stress reduction in college students through the use of TTM. According to Callaghan, Khalil & Morres, (2010) TTM is a modest predictor of stages of behaviour change among young people where its variables shape movement, self-efficacy, behavioural processes and pros over time being strongest predictors of stress reduction. TTM is not a strong predictor for exercise prediction as those remaining active at follow-up and baseline and inactive (contemplation or precontemplation) to maintenance stage (active) as one anticipate through stages of TTM. King et al., (2013) studied the importance of vigorous physical activity affected perceived benefits, cues to actions, barriers through social support (parent involvement). Correlation between cues to exercise and perceived benefits was associated with vigorous physical exercise involvement thereby reducing stress and promoting their wellbeing. According to Tuah et al., (2011) TTM can be used for physical exercise and dietary changes for weight loss, emotional stress management affecting synergistic multiple behaviour promoting wellbeing and health. TTM SOC (stages of change) act as guideline or framework in designing of lifestyle modifications strategies as compared to usual care.   

Using HBM and TTM for Stress Management and Promotion of Health

Conclusion

From the above discussion, it can be concluded that behavior models act as framework or guidelines for promoting health and well-being among individuals. These models help to understand behavior and barriers to healthy living. The literature review conducted for illustrating the application of two major behavior models like TTM and HBM depicted that they act as theoretical framework for designing interventions for influencing positive health outcomes. In this discussion, models have been used for stress management among university (college) students. From the literature review, it can be concluded that these models are used to reduce stress by helping individuals change their perceptions of stressors, helping them to cope with it and improve their ability to manage stress and promote health and wellbeing.

References

Baldwin, A. S. (2013). Attitudes. In Encyclopedia of Behavioral Medicine (pp. 155-159). Springer New York.

Bamber, M. D., & Schneider, J. K. (2016). Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research. Educational Research Review, 18, 1-32.

Bell, A. S., Rajendran, D., & Theiler, S. (2012). Job Stress, Wellbeing, Work-Life Balance and Work-Life Conflict Among Australian Academics. E-Journal of Applied Psychology, 8(1).

Bistricky, S. L., Harper, K. L., Roberts, C. M., Cook, D. M., Schield, S. L., Bui, J., & Short, M. B. (2017). Understanding and Promoting Stress Management Practices Among College Students Through an Integrated Health Behavior Model. American Journal of Health Education, 1-16.

Callaghan, P., Khalil, E., & Morres, I. (2010). A prospective evaluation of the Transtheoretical Model of Change applied to exercise in young people. International journal of nursing studies, 47(1), 3-12.

Coulson, N. S., Ferguson, M. A., Henshaw, H., & Heffernan, E. (2016). Applying theories of health behaviour and change to hearing health research: Time for a new approach. International journal of audiology, 55(sup3), S99-S104.

Evangelia, K., & Spiridon, K. (2011). Stages of change, self-efficacy and stress management perceptions in first year undergraduate students. International Journal of Psychology and Behavioral Sciences, 1(1), 24-32.

Horiuchi, S., Tsuda, A., Kim, E., HONG, K. S., PARK, Y. S., & Kim, U. (2010). Relationships between stage of change for stress management behavior and perceived stress and coping. Japanese Psychological Research, 52(4), 291-297.

King, K. A., Singh, M., Bernard, A., Merianos, A. L., & Vidourek, R. A. (2012). Employing The Health Belief Model To Examine Stress Management Among College Students. American Journal of Health Studies, 27(4).

King, K. A., Vidourek, R. A., English, L., & Merianos, A. L. (2013). Vigorous physical activity among college students: using the health belief model to assess involvement and social support. Archives of Exercise in Health and Disease, 4(2), 267-279.

Maddux, J. E., & Kleiman, E. M. (2012). Self?efficacy. The Wiley Handbook of Positive Clinical Psychology, 89-101.

Orji, R., Vassileva, J., & Mandryk, R. (2012). Towards an effective health interventions design: an extension of the health belief model. Online journal of public health informatics, 4(3).

Prochaska, J. O. (2013). Transtheoretical model of behavior change. In Encyclopedia of behavioral medicine (pp. 1997-2000). Springer New York.

Rabalais, T. L. (2015). Understanding the impact os stress, irrational health beliefs, and health behaviors among adults18-45.

Rizer, C. A., Fagan, M. H., Kilmon, C., & Rath, L. (2016). The Role of Perceived Stress and Health Beliefs on College Students’ Intentions to Practice Mindfulness Meditation. American Journal of Health Education, 47(1), 24-31.

Skinner, C. S., Tiro, J., & Champion, V. L. (2015). The health belief model. Health behavior: theory, research, and practice. 5th ed. San Francisco (US): Jossey-Bass, 75-94.

Tuah, N. A., Amiel, C., Qureshi, S., Car, J., Kaur, B., & Majeed, A. (2011). Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev, 10.

Wu, Y., & Edmondson, L. (2017). Testing Health Models In A Fitness Program. American Journal of Health Studies, 32(1).