Health Belief Model Dimensions Research Articles

Health beliefs and attitudes toward Influenza and COVID-19 vaccination in Portugal: a study using a mixed-method approach.

Vaccination is one of the most effective population strategies to prevent infectious diseases and mitigate pandemics, and it is important to understand vaccine uptake determinants since vaccine hesitancy has been increasing for the past few decades. The Health Belief Model (HBM) has been widely used for understanding vaccination behavior. The current study aimed to assess influenza vaccine (IV) non-uptake and attitudes toward COVID-19 vaccination, two important respiratory diseases with similar symptoms, and routes of transmission in the Portuguese population. We conducted a cross-sectional study using a panel sample of randomly chosen Portuguese households. A total of 1,050 individuals aged 18 years and over responded to a telephone or online questionnaire. Through a mixed-method approach, we employed thematic content analysis to describe reasons for not taking the IV, considering the HBM dimensions, and quantitative statistical analysis to estimate IV and COVID-19 vaccine coverage. The IV uptake for the overall population was 30.7% (CI 95%: 26.5, 35.2). Susceptibility was found to be a main factor for IV non-uptake, followed by barriers, such as stock availability and fear of adverse effects. The uptake of the COVID-19 vaccine was very high in the study population (83.1%, CI 95%: 13.6%-20.9%). There was a high perception of COVID-19-associated severity and fear of the consequences. Individuals who reported IV uptake seemed to perceive a higher severity of COVID-19 and a higher benefit of taking the COVID-19 vaccine for severe complications. Thus, the population does not seem to consider influenza to be a health risk, as opposed to COVID-19, which is considered to be a possibly severe disease. The association between IV uptake and COVID-19 perceptions highlights that an overall attitude toward vaccination in general may be an important individual determinant.

Hepatitis B vaccine among healthcare workers: factors associated with the dimensions of the Health Belief Model.

To investigate the association between the dimensions of the Health Belief Model (HBM) and complete vaccination for hepatitis B among healthcare workers (HCW). Cross-sectional epidemiological study with HCW in Primary Health and Medium Complexity Care. Univariate and bivariate analyses were performed to test the association between the outcome variable (complete vaccination for hepatitis B based on self-report) and the variables of the HBM dimensions. Prevalence ratio (PR) and its respective 95% confidence intervals (95%CI) were calculated. 453 HCW participated. The prevalence of complete vaccination for hepatitis B was 56.9%. In the final analysis model, the following variables were associated with complete vaccination for hepatitis B: chances of having hepatitis B (PR=1.73) - related to the susceptibility dimension; disease severity (PR=0.74) - related to severity; reduced risk of absenteeism (PR=1.29) - related to benefits; not spending time to get vaccinated (PR=1.41) and not worrying about Events Supposedly Attributable to Vaccination or Immunization (PR=1.43) - related to barriers. The completeness of the hepatitis B vaccination schedule, reported by the investigated HCW, reveals the prevalence is below the target established by the Ministry of Health, which follows the national scenario of low coverage presented for other age groups. Understanding the risk perception and severity of hepatitis B can contribute to increasing the prevalence of vaccination for this infection.

Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh.

The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance. Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy. These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

Health Belief Model (HBM) and vaccination during pandemics

IntroductionWith the COVID-19 pandemic recognized as a major threat to human health, promoting vaccination is of paramount importance to public health.ObjectivesTo examine the association between factors of the Health Belief Model (HBM) and intentions to be vaccinated against COVID-19, when a vaccine becomes available.MethodsA literature review has been made through PubMed database.ResultsThe HBM dimensions “perceived barriers”, “perceived benefits” and “perceived severity” were considered to be significant predictors of acceptance of vaccinations. The HBM constructs of cues to action (trust in third-party information sources), perceived severity of and susceptibility to COVID-19, and beliefs about the protection benefits of a COVID-19 vaccine, subsequently may elicit willingness to vaccinate. Individual predictors of vaccination were believing the vaccine is effective at preventing COVID-19, recalling their doctor recommending the vaccine. Common perceived barriers against vaccination included believing the vaccine could give people the virus, believing the vaccine can make individuals ill afterwards and preferring to develop immunity “naturally”. Patients who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines.ConclusionsHBM is an effective tool for identifying facilitators and barriers to health behaviors. Health promotion should make use of the HBM, as the model provides a theoretically understanding of the dynamics that may enable the success of important health-related policy in the wake of COVID-19 and future pandemics and identifies the communication mechanisms that must be leveraged by governments and authorities in enforcing policy.DisclosureNo significant relationships.

Pregnancy Activity Levels and Impediments in the Era of COVID-19 Based on the Health Belief Model: A Cross-Sectional Study.

Physical activity (PA) and exercise benefit both the mother and the fetus. Many pregnant women avoid or severely limit PA, leading to complications before and after delivery. This study elucidated the precise effect of each moderator variable on prenatal physical activity (PPA) by examining demographic factors, the PPA-related health belief level (HBL), and the current PPA level. The health belief model (HBM) in conjunction with the international prenatal physical activity questionnaire was used. The HBL in pregnant parous women (PPW) (3.42) was significantly higher than that in nonpregnant nulliparous women (NNW) (3.06). The PPA level in pregnant nulliparous women (PNW) (5.67 metabolic equivalent-hours per week (MET-h/week)) was lower than in the PPW (6.01 MET-h/week). All HBM dimensions (except for perceived barriers) were positively correlated with exercise expenditure in both PNW and PPW. According to the regression tree, participants in PNW aged ≤ 23 years with annual household incomes > CNY 100,001–150,000 had the highest energy expenditure (10.75 MET-h/week), whereas participants in PPW with a perceived benefit score of >4 had the highest energy expenditure (10 MET-h/week). The results demonstrated that the HBL in all groups was acceptable, whereas the PPA level was lower than the recommended PA level. In both PPW and PNW, the HBL was most strongly correlated with exercise expenditure. There is an urgent need to organize public-interest courses to alleviate household expenditure, raise the HBL about PPA in pregnant and NNW, and ensure personal health in the context of COVID-19.

Application of the health belief model to explain public perceptions, travel intentions and actions during COVID-19: a sequential transformative design

PurposeThis paper uses a supplemented health belief model (HBM) to explain the risk perception of COVID-19 coronavirus infection by potential and actual domestic and international travelers (from primarily European countries) in the early pre-vaccine phase of the pandemic and its influence on their travel intentions, decisions, and actions. With a health crisis of this magnitude, it is vital to understand the effect of COVID-19-associated containment measures and safety industry strategies in abating public fear and apprehension associated with non-essential travel.Design/methodology/approachThe authors used a sequential transformative design consisting of a (QUAN + Qual) survey to explore the HBM dimensions. The questions in the quantitative part of the survey were disseminated online examine perceptions of the severity and susceptibility of the disease, travel risks and willingness to travel. The questions in the qualitative face-to-face survey examined, how international/cross-border travelers (from Spain and Germany) perceive the benefits and barriers of personal protective behavior and the potential influence of cues to action.FindingsResults suggest that despite potential fear arousal and confusion associated with this infectious disease, people were willing to travel during periodic on-and-off travel restrictions and perceive the benefits of such travel as outweighing barriers like wearing masks, social distancing and other containment measures.Research limitations/implicationsThe conceptual model enabled the capture of real-time traveler's feelings about the benefits of traveling in the presence of the coronavirus and their perceptions of COVID-19 safety strategies used at destinations. This study adds to the lack of existing knowledge about potential psychological factors influencing travel decisions and behavior, including self-protective behavior. As borders reopen and we progress towards tourism and hospitality recovery, the results of this study can assist organizations, including health officials and governments, by reminding them of the likelihood of residual public fear when planning their COVID-19 safety strategies.Originality/valueGiven the scarcity of COVID-19 research on people's travel intentions and behavior following periods of social isolation due to lockdowns and border closures, this study captures sample public perceptions at two stages early in the pandemic. It is the first to apply all of the HBM dimensions with the addition of travel risk as a construct to investigate people's travel intentions and behaviors without vaccinations or treatments and to include cues to action in the investigation.

Incidence and Predictors of Sero-Conversion among HIV Discordant Couples at Amhara Region Selected Public Hospitals, Northwest Ethiopia, 2018: A Mixed Cohort Study

Background: Human immunodeficiency virus positive status disclosure deficit continues to drive the infection transmission. The major causes for expansion of HIV infection in developing were due to HIV infected individuals continue to have unprotected sex without informing their status to their sexual partner(s) who may be of negative or unknown sero-status. In the Ethiopia regarding disclosure deficit among people living with HIV there is no adequate findings. Thus, the aim of this study was to assess magnitude of disclosure deficit experienced by people living with HIV and application of the Health Belief Model at Nekemte Specialized Hospital Western, Ethiopia, 2020. Methods: A facility based cross-sectional study was conducted to explore HIV disclosure deficit of people living with HIV at ART Clinic of Nekemte specialized hospital, Western Ethiopia from March 5 to April 15, 2020. Systematic random sampling was used to recruit 380 PLHIV. Participants were interviewed to obtain socio-demographic and health belief related data. Relevant medical history was obtained from participants' chart records. The collected data were processed and analyzed using Epi data version 3.1 and STATA version 14.0. Binary logistic regression analysis with 95% CI was conducted. Results: The mean age of the 380 PLHIV was 31 (SD± 8.9) years. One fourth, (25%) of participants experienced disclosure deficit. Delayed to use, low level of education, using traditional healing and respondents’ level of knowledge were significantly associated with disclosure deficit. Importantly, Disclosure deficit had significantly affected by respondents’ perceived threat, perceived stigma and perceived low social support. Conclusion: Magnitude of disclosure deficit was low. Disclosure deficit is more likely when the patient use traditional healing, delayed to start ART, has lower level of education, and perceives stigma and low social support. This finding also insight that the health belief model dimensions would be a valuable framework for providers, planners and policy makers to develop guidelines and policies for early and further HIV sero-status disclosure.

The Association between Health Beliefs and Fall-Related Behaviors and Its Implication for Fall Intervention among Chinese Elderly

To apply the Health Belief Model (HBM) to fall prevention of the elderly and estimate fall health beliefs and their relationships with fall-related behaviors, a citywide cross-sectional study was conducted among people aged 60 years or over in 13 out of 16 districts in Shanghai, China, in September 2018. A total of 5833 participants were investigated. Of this, 43.4% were male; 48.8% were aged 60–69; 18.1% were uneducated; and 50.3% were living in urban areas. People who were older, less educated, living in rural areas generally had lower scores in the 7 HBM dimensions and also had lower proportions of fall risk-reduction behaviors, except that the less educated elderly were more likely to participate in exercise and training and the rural elderly were more likely to check house environment and participate in exercise and training (p < 0.001). The HBM dimensions were generally positively correlated with the risk-reduction behaviors except that “perceived severity” was negatively correlated with four risk-reduction behaviors and behavior number, “cues to action” was negatively correlated with purchasing shoes, and “perceived benefits” was negatively correlated with participating in exercise activities and fall prevention training (p < 0.05). When HBM is applied in the field of fall prevention, the interpretation of the results of each dimension has its characteristics in the fields of injury research. Fall prevention strategies should focus on improving the health beliefs and behaviors in those who were older, less educated and living in rural areas, implementing different levels of fall prevention activities to meet different needs, improving the accessibility and applicability of related resources, and raising the organizational level of related fall prevention activities.

Investigating ‘No Shows’ at a Hospital-Based Pediatric Sickle Cell Disease Clinic

BACKGROUND: In sickle cell disease (SCD), preventing all pain crises or other serious complications is not possible. When consistently followed by a health provider, some complications are avoidable. Patients lose vital opportunities for health monitoring/education when appointments are missed, increasing risk of hospitalization or mortality. Forgetfulness, disease risk/symptom severity perception, transportation, long clinic wait times, scheduling and work/school commitments are examples of factors keeping patients from appointments. An understanding of relevant benefits of and barriers to appointment keeping is essential to overcoming the barriers and promoting the benefits. Appointment keeping behaviors are multi-dimensional and often related to many of the social determinants of health. The Health Belief Model (HBM) is a theoretical framework previously used to investigate appointment keeping. Exploring an individual's general health motivations, perceived disease risks and the role of specific behaviors to reduce risks can be informative in this context. OBJECTIVE: The purpose of this research was to explore how health beliefs affect the appointment keeping behavior of pediatric SCD patients and caregivers at a hospital-based outpatient clinic in central Illinois. METHODS: A 53 question multiple-choice questionnaire was utilized to assess health beliefs. This modified version of a validated HBM questionnaire was changed with permission from the creator (Mirotznik et al., 1998) to better represent the symptoms/complications of SCD. Questions determined participants' general health motivation (GHM), perceived susceptibility to the complications of SCD (PSC), perceived severity of SCD (PS), perceived benefits of doctor visits (PB), perceived costs of doctor visits (PC) (i.e. finding transportation, the energy or time to keep visit, wait at clinic, having blood drawn, talking multiple people at one visit, etc.) and intent to keep doctor appointments (INT). The Cronbach alpha coefficient was .87, suggesting good internal consistency reliability. Participants were recruited through convenience sampling at scheduled clinic appointments. A chart review measured overall appointment keeping. RESULTS: In total, 32 individuals (caregiver or patient ≥14 years) completed the questionnaire. There was a significant difference in 'no show' appointment rates for males versus females (Mean= 5.4% 'no show' rate for males vs Mean=17.6% for females, p=.008, two-tailed t-test). There was not a significant difference in 'no show' rates based on the gender of the child (&lt;14 years), participant's city of residence or child's SCD type. There was a small, positive correlation between the age of the child and 'no show' rate (r =.175), but it was not statistically significant. There were statistically significant correlations between INT and GHM (r =.523), PC (r = -.584), and 'no show' rates (r = -.426). PSC had statistically significant correlations with PS (r =.670), PB (r = -.370), and PC (r = .378). PB had a statistically significant correlation with PC (r = -.370). A regression analysis for INT with GHM, PSC, PS, PB and PC as variables explained 66.8% of the variance in intent. Of all the variables, PC made the largest unique contribution (beta = -.69). PS and GHM also made statistically significant contributions (beta = -.35 and .25, respectively). CONCLUSIONS: Three HBM dimensions were uniquely associated with INT. GHM was positively associated, PS negatively associated and PC negatively associated. Participants' PSC and PS play an important role in the perception of the benefits and costs to appointment attendance. Future work to improve appointment keeping will require a larger focus on minimizing costs of doctor visits. Furthermore, effectively enhancing GHM could also improve attendance, potentially lessening the disease process and improving overall wellness. PS negatively correlates with INT. Although counterintuitive, these findings are congruent with those found in lupus patients by Mirotznik et al. Patients with higher PS may have acute medical visits more often, leaving them unable to attend additional scheduled preventative visits because of the costs. Additionally, if some preventative care tasks are added to acute visits when appropriate (as in our institution), the patients/caregivers may see less benefit in attending the next scheduled comprehensive visit. Table Disclosures No relevant conflicts of interest to declare.

Development and Validation of a Mexican Version of the Champion’s Health Belief Model Scale for Breast Cancer Screening

Although the Champion's Health Belief Model Scale for breast cancer screening has been adapted and validated in different populations worldwide, a Spanish version for the Latin American population is still not available. The aim of this study was to adapt and validate the Spanish version of the Champion's Health Belief Model Scale for mammograms for use with Mexican women and determine the sociodemographic, clinical, and health belief model variables which influence undergoing a mammogram. A descriptive, cross-sectional study was designed. Participants included 612 women aged 40years and above who attended a public tertiary hospital. An exploratory factor analysis was conducted, from which six factors with adequate loadings were obtained. In addition, Cronbach's alpha was used to obtain a reliability coefficient of 0.68-0.94. To obtain criterion validity, a binary logistic regression analysis was conducted, with the mammogram being the dependent variable and sociodemographic, clinical, and health belief model dimensions being the predictors; perceived benefits was the variable that most influenced the obtaining of mammography. This Spanish version of the Champion's Health Belief Model Scale for breast cancer screening for Mexican women was found to be valid and reliable, which means it could be a useful tool in identifying beliefs surrounding breast cancer screening.

Beliefs and attitudes towards the influenza vaccine in high-risk individuals.

Societal and economic impact of influenza is mainly due to influenza infection of specific groups, who are at higher risk of health complications leading up to hospitalisation or death. In this study we applied the health belief model (HBM) to evaluate beliefs and attitudes towards influenza disease and vaccine in community-dwelling high-risk individuals (aged 65 or more or having a chronic disease). We conducted a mixed-method study using data collected through a telephone survey of a household unit sample. We used thematic analysis to map responses to HBM dimensions and Poisson regression to model vaccine non-uptake prevalence. The main self-reported reason not to take the vaccine referred to the susceptibility dimension: 'considering oneself to be a healthy person' (29·8%, (95% confidence interval (CI) 22·1-38·7)). Bad experiences after vaccination - barriers dimension - were also commonly reported (17·0%, (95% CI 10·8-23·8)). Vaccine non-uptake prevalence was 22% higher in those who did not consider themselves susceptible to contract flu (Prevalence Ratio (PR)=1·22, (95% CI 1·0-1·5)) and 18% lower in those who did not consider that the vaccine causes flu symptoms (PR=0·82, (95% CI 0·68-0·99)). Results suggest that high-risk individuals do not think of themselves susceptible to influenza infection and fear adverse events following immunisation.

Maternal knowledge, attitudes and beliefs regarding gastroenteritis and rotavirus vaccine before implementing vaccination program: Which key messages in light of a new immunization program?

In July 2010, the National Advisory Committee on Immunization (NACI) recommended the systematic administration of rotavirus vaccines for all infants in Canada. According to the Erickson and De Wals framework, multiple factors need to be evaluated before implementing such a decision, including the study of the acceptability of this vaccine by the general population.A cross-sectional survey was conducted from February 10 to February 18, 2011, at the Sherbrooke University Hospital Center in the province of Quebec. A questionnaire, based upon the Health Belief Model (HBM) and theoretical planned action, was self-administered to pregnant or early post-partum women. The variables collected included socio-demographic data, past experience with gastroenteritis, cues to vaccination and HBM dimensions. The associations between questionnaire variables and vaccination intention were assessed using univariate and multivariate analyses.Of the 343 respondents, only 29% had already heard about rotavirus vaccination and among these, the intention of vaccination was 74%. In multivariate analysis, having a perception of infant vulnerability to gastroenteritis (OR=2.3, 95% CI 1.3–4.0) and having no other child at home (OR=2.3, 95% CI 1.3–4.2) were factors positively associated with a higher intention of vaccination, contrary to having already heard about the rotavirus vaccine in the media (OR=0.5, 95% CI 0.2–0.9). The three cues independently associated with intention of vaccination were the reimbursement of the vaccine (OR=3.0, 95% CI 1.6–5.7), its recommendation by a doctor (OR=21.2, 95% CI 5.8–75.9) and its protection against the most severe forms of gastroenteritis (OR=4.4, 95% CI 1.4–13.6).To improve the success of this new vaccination program, several key messages should be integrated in the information made available to the general population: (1) rotavirus gastroenteritis is a mandatory infection for every child <5 years; (2) the vaccine is reimbursed and included in the provincial vaccination program; and (3) the vaccine protects against the worst forms of gastroenteritis. Finally, support should be offered to physicians as they play a key role in public acceptance of new vaccines.

Determinants of A (H1N1) vaccination: Cross-sectional study in a population of pregnant women in Quebec

Background Because of the risk of complication, pregnant women were a priority target for vaccination during the A (H1N1) pandemic influenza. In Quebec, 63% of pregnant women were vaccinated, which is a higher rate than vaccination against seasonal influenza. However, the behaviour of pregnant women relative to the vaccination during the H1N1 pandemic is unknown. The present study was aimed at identifying factors influencing the decision-making of pregnant women regarding H1N1 vaccination. Methods A cross-sectional survey was conducted in February 2010 in pregnant women or in early postpartum at the Sherbrooke University Hospital Centre using a self-administered questionnaire based on the Health Belief Model (HBM). Data items collected were: socio-demographic data, vaccination status, information sources consulted, knowledge on vaccination, and the HBM dimensions: effectiveness and risks of vaccination, severity and vulnerability towards the influenza. The associations between questionnaire variables and vaccination status were assessed by univariate and multivariate analysis. Results Of the 250 women interviewed, 95% knew that the vaccination was recommended, but only 76% received the vaccine. Variables positively associated with vaccination were late vaccination during pregnancy (OR = 7.3, 95% CI 2.1–25.3), belief in the efficacy of the vaccine (OR = 7, 95% CI 2–23.4), and consultation of the Pandémie-Québec website (OR = 4.5, 95% CI 1.5–13.4). However, the belief that the vaccine had not been adequately tested (OR = 0.08, 95% CI 0.02–0.35) and consultation of mainstream websites (OR = 0.22, 95% CI 0.06–0.81) were associated with lower vaccination rates. Conclusions The vast majority of pregnant women were aware of the recommendations relative to A (H1N1) vaccination. Internet media played an important role in their decision to get vaccinated. Better information on the safety of the vaccine must be prepared for future pandemics.

The Human Genome Project: Implications for Families

The Human Genome Project was the international research effort whose goal was the mapping and understanding of all human genes (National Human Genome Research Institute [NHGRI], 2005). Approximately 30,000 to 40,000 human genes have been identified and located by the Human Genome Project (NHGRI). The Human Genome Project has created a dramatic increase in information regarding the structure, organization, and function of human genes. As a result, the number of genetic tests available continues to grow. This increase in the availability of testing raises important social and ethical issues for all families, but especially for families with children who have genetic-related disabilities. Andrews and colleagues (1994) reported on the concerns from individuals with disabilities about the implications of increased genetic testing. Little is known about the perceptions of, and attitudes toward, the implications of the Human Genome Project among families who have children with genetic-related disabilities. This gap in knowledge limits the development of effective educational strategies to assist families with decision making regarding the family and health care implications of the Human Genome Project. Genetic disease is a family issue; it affects not only the individuals with genetic conditions, but also the parents, siblings, extended family members, and community. For almost 40 years, social workers have been involved in providing genetic services. Sylvia Schild began to define the role of social workers in genetic services in 1966 (Taylor-Brown & Johnson, 1998). In 1984, Schild and Black insightfully projected that the most pressing task facing the social work profession would be preparing social workers for effective practice in genetics (Taylor-Brown & Johnson). The relevance of the Human Genome Project to social work practice and policy has continued to grow, and its significance is rapidly increasing as families address the implications on their family's health and health care. The purpose of this study was to explore how families identify information and to assess their perceptions of, and attitudes toward, the implications of the Human Genome Project on their family's health care. METHOD Face-to-face structured interviews were conducted; the Wayne State University Human Investigation Committee approved the study throughout the study period. The Health Belief Model (HBM) served as the conceptual framework for the study. Focusing on preventive health behaviors, the HBM's dimensions of perceived susceptibility and perceived threat guided the development of the survey instrument, along with the existing professional and public literature (Janz & Becker, 1984). With input from an interdisciplinary group of key informants, it was determined that case scenarios representing various family situations would be constructed, along with follow-up questions, to explore the perceptions and attitudes about the implications of the Human Genome Project on their family's health care and to identify where families learned their information. Following assessment by the key informants, with particular attention to the feedback from the family members of children with genetic-related disabilities, hypothetical case scenarios were developed focusing on themes relating to the following: insurance coverage following a job change; new treatments or cures since the discoveries of the Human Genome Project; genetic testing for young adult siblings of children with genetic-related disabilities; and prenatal testing in future pregnancies and health care coverage. The readability of the survey instrument was established at approximately grade 9, according to the Flesch-Kincaid readability level. The test-retest reliability of the instrument, assessed by interviewing one parent a second time, 12 months after the initial interview, was greater than 90 percent. Eligibility criteria for study participation included being the mother or father of a child who has a genetic-related disability, being at least 18 years of age or older, and being able to respond to interview questions in English. …

Knowledge and Attitudes Towards HIV/STD Among Indian Adolescents

ABSTRACT This is a secondary data set of a study conducted in 1996 among 1230 Indian students in the 11th and 12th grades in Bombay. The aim of the study is to examine the relationship of knowledge, health beliefs, attitudes, and risk behaviors to HIV/STD risk intentions among Indian adolescents and also to examine predictive utility of the Health Belief Model (HBM). Correlations, multiple regression, and logit regression were applied to predict the variables related to the HBM dimensions. The overall explanatory power of the models for either dimension of the HBM or preventive intention with knowledge about HIV/STD was modest. These results suggest that either the models are lacking some important variables or the measurement of key variables is inadequate. Another limitation is that the data collection tool was a secondary subset, and only some relevant questions were chosen to examine the aim of the study. The HBM is partially, but significantly, related to the likelihood of recommendation of preventive intention changes. Individual perception of a disease is more likely to depend upon the language spoken at home because Indian adolescents may assimilate health messages more completely when those messages are conveyed in the local language. Parent education levels do not influence preventive intention changes. However, it was observed that a low level of maternal education encouraged children's preventive intention. Girls especially have shown a higher intention to practice safer sex behaviors. Knowledge about HIV/STD appears to influence preventive intention to practice safer sex behaviors. It is very important to teach Indian adolescents the proper use of condoms, and such education should be given in the local language. Indian male adolescents are more likely to report that they engage in risky behavior than female adolescents. Indian adolescents need greater access to relevant health education.

Using the health belief model to explain clinic appointment-keeping for the management of a chronic disease condition.

Broken appointments have untoward repercussions for patients' health and well-being. Although the literature on missed appointments has been largely atheoretical, several studies have tested the Health Belief Model (HBM) in this context. Those studies have found HBM dimensions are not predictive of keeping appointments for the management of a chronic condition. Given several limitations that characterize these studies, questions can be raised about the validity of this conclusion. This study investigated the utility of HBM for explaining appointment-keeping for Systemic Lupus Erythematosus (SLE), a potentially fatal chronic disease. A questionnaire, operationalizing HBM dimensions and exhibiting acceptable psychometric properties, was developed for this research and administered to 153 SLE patients enrolled at an outpatient clinic of a major teaching hospital. In addition to measuring intention to keep appointments, data were abstracted from medical records regarding actual appointment-keeping during 12 months prior to and 6 months following questionnaire completion. Regression analysis indicated that general health motivation and perceived severity of SLE were uniquely associated in the theoretically predicted direction with, respectively, intent and the percentage of scheduled appointments kept (PSAK) during the 12 month retrospective period. Perceived costs was associated in the expected direction with intent, 12 month retrospective and 6 month prospective PSAK. Typical of HBM research the effect sizes uncovered were modest in magnitude. Questions for future investigation are discussed.

A meta-analysis of studies of the Health Belief Model with adults.

The Health Belief Model (HBM) relates a socio-psychologic theory of decision making to individual health-related behaviors. We conducted a meta-analysis of the relationships between four HBM dimensions (Susceptibility, Severity, Benefits and Costs) and health behavior on 16 studies that measured all four of the dimensions, measured a behavioral dependent variable and included some measures of reliability, minimal criteria for establishing the validity of the dimensions. Mean effect sizes were computed for all the studies, subgroupings representing studies of screening, risk reduction and adherence to medical regimen, and prospective and retrospective study designs. Of 24 mean effect sizes, 22 were found to be positive and statistically significant. The actual variance accounted for ranged from 0.001 to 0.09. Homogeneity was rejected for 15 of the 22, however, suggesting that the same underlying construct was not measured. Retrospective studies were found to have significantly large effect sizes for benefits and costs and smaller effect sizes for severity when compared to prospective studies. The weak effect sizes and lack of homogeneity indicate that it is premature to draw conclusions about the predictive validity of the HBM as operationalized in these studies. Our finding of only 16 studies meeting minimal criteria for valid representation of the HBM dimensions indicates that future studies should focus more on such issues.

Psychological and social characteristics of attenders for breast screening

Abstract Demographic characteristics, health behaviour and knowledge of breast cancer were assessed in 183 women from a regional breast screening unit and compared with those of 182 women from a breast clinic and 41 control subjects. A questionnaire yielded information on (i) demographic characteristics and cancer-related behaviours including breast self-examination (BSE), use of screening and promptness of presentation of breast symptoms in the clinic group, (ii) the extent and effects of knowledge about breast cancer and (iii) the role of Health Belief Model dimensions. Results showed the screening unit attenders to be significantly older and to be significantly more likely to be from higher social classes. Differences between the groups in health beliefs and knowledge did not remain once the effects of age and social class were partialled out. While attitudes towards BSE and its practice related to health beliefs. only a minority of the women indicated that they practised BSE with any regularity. The r...

The Health Belief Model: a decade later.

Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.