Alas, another weekend is just about at an end. I thought I'd use the end of the week to reflect on what we covered in HBHE 600 last week, namely the Health Belief Model.
(everyone's favorite depiction of the Health Belief Model, even though self efficacy is missing...)
The Health Belief Model is the first of many theories of health behavior that we cover in class. The guts of it are pretty straightforward: if I perceive a threat to my health, and I perceive benefits to a preventive behavior and don't perceive barriers, I'm likely to make the behavior change (and if you're using a more updated version of HBM, you also need to have confidence in your ability to do the behavior). It's a popular theory to use: freak people out, tell them what they can do to avoid the problem, and maximize their confidence to do the behavior and minimize their barriers to action and they're more likely to take preventive action. The seasoned practitioner might be nuanced about targeting a threat (e.g., if you want to get teenagers to brush their teeth, how much do you highlight the threat of cavities and how much do you hype the threat of bad breath?), highlighting the right benefits (the benefit that motivates me is the idea that my hygienist will finally praise my brushing), targeting the most important perceived barriers (I'm ashamed to admit that I often think that brushing my teeth takes too much time) and building confidence in the right skills. On the face of it all, it's seems simple to implement.
Or so it seems. We often default to HBM constructs because they're well proven correlates of behavior, even if the relationships between constructs may be more complicated that the base model depicts (e.g., benefits and barriers matter more when threat perceptions are high... except when threat perceptions are super high and people often prefer to avoid the topic altogether). But how do you change something like the perceived benefits of a behavior? Preaching benefits oftentimes gets people to go in exactly the wrong direction. Take my dad, for example. If you tell him that going to the eye doctor will slow the progression of his vision loss, he's going to tell you "the (add a few expletives here) eye doctor never helps!" You've got to bait the guy in a way that makes him think about the benefits himself. Something like:
Me - "How's your vision, dad?"
Dad - "Terrible."
Me - "Sorry to hear. Maybe there's something we can do?"
Dad - "Well, I suppose we could go see Dr. Bob."
My dad's the exception and not the rule on many things, but reactance is a common reaction to threats to personal freedom. We can actually cause people to perceive fewer benefits to preventive behaviors exactly by trying too hard to change them.
From a public health perspective, I don't think we should get too hung up on this issue and suddenly start creating reverse-psychology PSAs. There are lessons to be learned from the literature on motivational interviewing and "rolling with resistance," though, that might help if we found ways to implement those strategies at a population level...
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