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Health Belief Model

  1. The Health Belief Model is a concept from social psychology. The model is related to behaviour change towards health and is developed to understand as well as predict actions and behaviours related to health and use of healthcare services. Various studies have been conducted to get a better understanding of this model. One such study was conducted by Das and Evans in 2014 and it explores the barriers to weight management among undergraduate students with the help of the Health Belief Model.

A total of 45 undergraduate students participated in this study. The participants were first-year students, enrolled in the regular full-time program, non-athletes and between the ages of 18-20. Data was collected, after obtaining consent from the participants, through group discussions using the Nominal Group Technique (NGT). Perceptions of the participants regarding the barriers and advantages of weight management were discussed. A total of 8 NGT sessions were held, out of which 6 consisted of both male and female participants, 1 consisted of only females and 1 had only males.

The questions were asked based on the following constructs of the Health Belief Model – Perceived Sustainability, Perceived Seriousness, Health, Perceived Benefits, Perceived Barriers, Self-efficacy and Cues to Action. In terms of perceived susceptibility, all 3 groups stated that barriers to weight management would impact one’s physical health. The all-male group also stated that improper weight management would affect potential romantic prospects. For perceived seriousness, all three groups stated that the inability to manage weight would have a negative impact on one’s quality of life. However, an interesting finding in the all-male group was their belief that poor weight management would negatively impact their careers and finances, while the all-female group stated that it would hamper their independence. The perceived barriers to weight management by all the groups were lack of time, along with lack of motivation, social support and a scarcity of healthy food options. Findings for self-efficacy portray that the students lack awareness with respect to which food items provide nutrition and which do not. Information about healthy food and time-management were the areas that required attention from the participants. In cues for actions, all the three groups stated that getting involved in a weight management course, preferably one that is sponsored by the university, would be a beneficial course of action for them.

In conclusion, this study helped understand the health beliefs of college students and the factors impacting such beliefs by assessing the transtheoretical model. College is a transitionary phase for many and the changes in one’s lifestyle may have health-related effects which are not always positive, such as a risk for obesity or chronic illnesses. Hence, it is important to make healthy lifestyle decisions such as eating healthy, enrolling in a weight management program and developing hobbies that require physical activity. Awareness should be made among students to opt for a healthier lifestyle and their daily activities should be scheduled in such a manner that they have time for indulging in physical activities. Universities should come up with cost-effective ways to get their students to switch to a healthier lifestyle.

  1. The Transtheoretical Model of behaviour change is a concept which examines the preparedness of an individual to adopt healthy behaviour, comes up with strategies to be implemented and helps provide guidance to the individual to adapt to the changes. The transtheoretical model has six stages – pre-contemplation, contemplation, preparation, action, maintenance and termination. Precontemplation is the stage when people are unaware of their problematic habits and the benefits of changing these habits. Contemplation involves the initiation of the thought process and acknowledgement that behaviour may be problematic and requires to be changed. Confusion about changing the behaviour still prevails in this stage. In the preparation stage, people are ready to make the changes within the next 30 days. Small changes are employed in one’s life with the determination and belief that it will make a difference to one’s health. During the action stage, recent changes have been made, with the intention to continue with it and make progress in changing the problematic behaviours. In the maintenance phase, people have been undergoing changes in behaviour for a while, intending to continue with it while moving forward. Efforts are being made to prevent relapsing to the earlier patterns of behaviour. Finally, during termination, people are confident that relapsing to previous patterns of behaviour will not take place and they do not even desire to go back to their older and unhealthier behaviour patterns. However, it is difficult and rare to reach this stage. 

College students are a vulnerable population due to the changes that they undergo, especially during the first year of enrolment. Due to keeping up with the various lifestyle changes and adjustments, they are prone to adopting unhealthy patterns of behaviour, such as eating unhealthy food and not getting enough time to exercise due to their hectic schedules.

A study was conducted among college students and predicting exercise behaviour using the transtheoretical model. This study was done by Elezim and others (2019) to explore how the transtheoretical model could be applied to predict behaviours related to exercise among college students in Macedonia. The factors assessed were self-efficacy expectation, decisions based on pros and cons, social support and enjoyment derived from exercising and the cumulative effect of these factors on behaviour change concerning exercise. A total of 1066 students participated in the study. They were asked to fill a questionnaire. The answers indicated that more than 67% of the students were inactive and were either in the pre-contemplation, contemplation or preparedness stage. 17.6% of the students were in the action stage and had been regularly active for 6 months or less, whereas 14.9% of the students were in the maintenance stage and had been active since more than 6 months.

The results of this study indicated that the constructs from the transtheoretical model were able to show the differences across various stages of exercise. Students in the action and maintenance stages displayed higher self-efficacy, were receiving more social support from peers and parents and benefitted more from physical activities as compared to the students who were in the pre-contemplation and contemplation stages. Students in the maintenance and action stages also derived enjoyment from exercising and being physically active in comparison to the ones who were still contemplating making the change. Hence, this study supports the claim that the transtheoretical model is an excellent way to predict the outcomes surrounding behaviour change among the college-going population. 

By examining the behaviour of students and understanding which construct of the transtheoretical model they are currently on, provides a better understanding on what their beliefs surrounding health are and whether they are likely to change anytime soon. It helps predict their behaviour and come up with appropriate strategies. Students who are on the pre-thinking stages, i.e., the pre-contemplation and contemplation stages, require different strategies of health promotion as the ones who are in the action and maintenance stages. The ones in the pre-thinking stages need to be made aware of the advantages and benefits of adopting a healthy lifestyle, what are the healthier food options that they can switch to and cost-effective ways of exercising and staying physically active on a regular basis. For the students who are in the action stages, guidance can be provided on what is working for them and what is not, is there anything more that they can do and how can they spread awareness regarding the benefits of adapting to a healthy lifestyle to their peers.

  1. Health and wellness are of extreme importance and should be taken seriously. The Health Belief Model is a concept developed by social psychologists in an attempt to explain the factors that either help people to adopt strategies that are beneficial for their health or the failure to keep up with such strategies and falling back to unhealthy patterns of living. Initially, it was used to understand why do people fail to adopt disease-preventing methods and the response of the patients to comply with medical treatments. According to the Health Belief Model, it is one’s personal beliefs that bring about change. The two important components of behaviours associated with health are the inclination of avoiding disease and by indulging in a specific action one can prevent the occurrence of a disease. The Health belief Model originally had four constructs. Later, the model was modified with the addition of two more constructs, making it a total of six constructs. These are as follows – perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action and self-efficacy.

Reading and understanding the articles and studies mentioned above have provided me with better understanding and clarity regarding the Health Belief Model and its ability to predict changes in behaviour. There are differences in outcomes-based one’s perception concerning barriers, benefits, severity and execution of the course of action. The model has also made me aware of my shortcomings regarding how I perceive health and what can I do to change my outlook concerning health and make adjustments to my lifestyle so that I am active and healthier in the future. Since I am a student, I am not left with a lot of time in my hands. Hence, time and motivation are the perceived barriers to a healthier lifestyle in my case. The benefits perceived by me are being healthy, less vulnerability to diseases, losing weight and physical attractiveness. Plus, I have always wanted to play at least one sport so this seems like the perfect opportunity. Perceived susceptibility in my case would be weight gain. My diet is not too healthy and if I remain inactive for too long, I am at risk of gaining weight and developing problems associated with weight gain. This outcome is not desirable for me and in order to prevent this, I must indulge in regular physical activities. I am aware of the severity or seriousness of not adopting a healthier lifestyle. By continuing with an unhealthy lifestyle, I am increasing the chances of developing diseases later, such as hypertension or heart related diseases. Hence, it is important that I begin now to take measures against such unhealthy outcomes. So, the cues to action that worked in my case and made me think of getting healthier were when I came across people my age diagnosed with diseases like diabetes and a neighbour my age was recently hospitalised due to a heart attack. When I see people, who are almost my age undergoing health issues that are connected to an unhealthy pattern of living, it makes me reconsider my habits and pushes me to adopt healthier alternatives and behaviours. Upon accessing my levels of self-efficacy, I am confident that by being disciplined, keeping to a schedule and being focused I can execute the changes that I have planned to make in my life, such as regular exercise, playing a sport and eating healthy. I am sure that with time, the changes will be integrated into my life and with time, I will move to a healthier version of myself.

References for Understanding Weight Management

Das, B. M., & Evans, E. M. (2014). Understanding weight management perceptions in first-year college students using the health belief model. Journal of American College Health, 62(7), 488-497. 

Elezim, A., Elezi, G., Gontarev, S., & Georgiev, G. (2020). Application of the Transtheoretical Model (TTM) to exercise behaviour among Macedonian college students.

The Transtheoretical Model (Stages of Change). (2019). School of Public Health, BUMC. https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/BehavioralChangeTheories6.html

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