What Is the Health Belief Model?

The Health Belief Model (HBM) is a tool that scientists use to try and predict health behaviors. Originally developed in the 195 s! and updated in the 19" s! it is based on the theory that a person#s $illingness to change their health behaviors is pri%arily due to the follo$ing factors&

Perceived Susceptibility 'eople $ill not change their health behaviors unless they believe that they are at ris(. Those who does not think that they are at risk of acquiring HIV from unprotected intercourse are unlikely to use a condom. Perceived Severity The probability that a person $ill change his)her health behaviors to avoid a conse*uence depends on ho$ serious he or she considers the conse*uence to be. If you are young and in love, you are unlikely to avoid kissing your sweetheart on the mouth just because he has the sniffles, and you might get his cold. n the other hand, you probably would stop kissing if it might give you !bola. Perceived Benefits +t#s difficult to convince people to change a behavior if there isn#t so%ething in it for the%. "our father probably won#t stop smoking if he doesn#t think that doing so will improve his life in some way. Perceived Barriers One of the %a,or reasons people don#t change their health behaviors is that they thin( that doing so is going to be hard. -o%eti%es it#s not ,ust a %atter of physical difficulty! but social difficulty as $ell. .hanging your health behaviors can cost effort! %oney! and ti%e. If everyone from your office goes out drinking on $ridays, it may be very difficult to cut down on your alcohol intake.

The Health Belief Model! ho$ever! is realistic. +t recogni/es the fact that so%eti%es $anting to change a health behavior isn#t enough to actually %a(e so%eone do it! and incorporates t$o %ore ele%ents into its esti%ations about $hat it actually ta(es to get an individual to %a(e the leap. These t$o ele%ents are cues to action and self efficacy. Cues to action are e0ternal events that pro%pt a desire to %a(e a health change. They can be anything fro% a blood pressure van being present at a health fair! to seeing a condo% poster on a train! to having a relative die of cancer. 1 cue to action is so%ething that helps %ove so%eone fro% $anting to %a(e a health change to actually %a(ing the change. +n %y %ind! ho$ever! the %ost interesting part of the Health Belief Model is the concept of self efficacy 22 an ele%ent $hich $asn#t added to the %odel until 19"". Self efficacy loo(s at a person#s belief in his)her ability to %a(e a health related change. +t %ay see% trivial! but faith in your ability to do so%ething has an enor%ous i%pact on your actual ability to do it. Thin(ing that you $ill fail $ill al%ost %a(e certain that you do. +n fact! in recent years! self efficacy has been found to be one of the %ost i%portant factors in an individual#s ability to successfully negotiate condo% use.

-ource& 3reen and 4reuter (1999) Health 'ro%otion and 'lanning & 1n 5ducational and 5cological 1pproach (third edition) Mountain 6ie$! .alifornia. Mayfield 'ublishing .o%pany.

Health Belief Model

7ro% 8i(ipedia! the free encyclopedia 9u%p to& navigation! search The Health Belief Model is a health behavior change and psychological %odel developed by +r$in M. :osenstoc( in 19;; for studying and pro%oting the upta(e of health services.<1= The %odel $as furthered by Bec(er and colleagues in the 19> s and 19" s. -ubse*uent a%end%ents to the %odel $ere %ade as late as 19""! to acco%%odate evolving evidence generated $ithin the health co%%unity about the role that (no$ledge and perceptions play in personal responsibility. <?= Originally! the %odel $as designed to predict behavioral response to the treat%ent received by acutely or chronically ill patients! but in %ore recent years the %odel has been used to predict %ore general health behaviors.<@=

[edit] Constructs

The Health Belief Model. The health belief %odel! developed by researchers at the A.-. 'ublic Health -ervice in the 195 s! $as inspired by a study of $hy people sought B2ray e0a%inations for tuberculosis. The original %odel included these four constructs&

'erceived susceptibility (an individual#s assess%ent of their ris( of getting the condition) 'erceived severity (an individual#s assess%ent of the seriousness of the condition! and its potential conse*uences) 'erceived barriers (an individual#s assess%ent of the influences that facilitate or discourage adoption of the pro%oted behavior) 'erceived benefits (an individual#s assess%ent of the positive conse*uences of adopting the behavior). 1 variant of the %odel include the perceived costs of adhering to prescribed intervention as one of the core beliefs.

.onstructs of %ediating factors $ere later added to connect the various types of perceptions $ith the predicted health behavior&

Ce%ographic variables (such as age! gender! ethnicity! occupation) -ocio2psychological variables (such as social econo%ic status! personality! coping strategies) 'erceived efficacy (an individual#s self2assess%ent of ability to successfully adopt the desired behavior) .ues to action (e0ternal influences pro%oting the desired behavior! %ay include infor%ation provided or sought! re%inders by po$erful others! persuasive co%%unications! and personal e0periences) Health %otivation ($hether an individual is driven to stic( to a given health goal) 'erceived control (a %easure of level of self2efficacy) 'erceived threat ($hether the danger i%posed by not underta(ing a certain health action reco%%ended is great)

The prediction of the %odel is the li(elihood of the individual concerned to underta(e reco%%ended health action (such as preventive and curative health actions).

HBM .riti*ue

-trengths& .o%%on2sense constructs easy for non2psychologists to assi%ilate and apply Has focused research attention on %odifiable psychological prere*uisites of behaviour Ma(es testable predictions& Darge threats %ight be offset by perceived costsE s%all threats by large benefits etc.

Di%itations&

.o%%on2sense fra%e$or( si%plifies health2related representational processes Theoretical co%ponents broadly defined therefore different operationalisations %ay not be strictly co%parable Dac( of specification of a causal ordering Feglects social factors

[edit] References
1. :osenstoc( +M (19;;)! G8hy people use health servicesG! %ilbank %emorial $und &uarterly !! (@)& 9HI1?>! 'M+C 59;>H;H ?. 3lan/ 4! De$is 7M! :i%er B4. GHealth Behavior and Health 5ducationG (? ?) +-BF >">95>151 @. Ogden 9. (? >). GHealth 'sychology& 1 Te0tboo(G +-BF 9>" @@5???;H@

Health Belief Model

The health belief %odel! developed by researchers at the A.-. 'ublic Health -ervice in the 195 s! $as inspired by a study of $hy people sought B2ray e0a%inations for tuberculosis. +t atte%pted to e0plain and predict a given health2related behavior fro% certain patterns of belief about the reco%%ended health behavior and the health proble%s that the behavior $as

intended to prevent or control. The %odel postulates that the follo$ing four conditions both e0plain and predict a health2related behavior& 1. 1 person believes that his or her health is in ,eopardy. 7or the behavior of see(ing a screening test or e0a%ination for an asy%pto%atic disease such as tuberculosis! hypertension! or early cancer! the person %ust believe that he or she can have the disease yet not feel sy%pto%s. This constellation of beliefs $as later referred to generally as Gbelief in susceptibility.G ?. The person perceives the Gpotential seriousnessG of the condition in ter%s of pain or disco%fort! ti%e lost fro% $or(! econo%ic difficulties! or other outco%es. @. On assessing the circu%stances! the person believes that benefits ste%%ing fro% the reco%%ended behavior out$eigh the costs and inconvenience and that they are indeed possible and $ithin his or her grasp. Fote that this set of beliefs is not e*uivalent to actual re$ards and barriers (reinforcing factors). +n the health belief %odel! these are GperceivedG or GanticipatedG benefits and costs (predisposing factors). H. The person receives a Gcue to actionG or a precipitating force that %a(es the person feel the need to ta(e action. The %odel soon changed shape $hen applied to another set of proble%s concerning i%%uni/ation and %ore broadly to (the variety of) people#s different responses to public health %easures and their uses of health services. +n these $ider applications! the %odel substituted a belief in susceptibility to a disease or health proble% for the %ore specific belief that one could have a disease and not (no$ it! $hich had been featured in 3odfrey Hochbau%#s original study as the %ost i%portant belief accounting for see(ing screening e0a%inations. +n the %id219> s! a %onograph devoted to the $ide2ranging applications of the %odel described its history and e0perience (Bec(er! 19>H). This $as soon follo$ed by a revie$ of the standardi/ed scales for %easuring its several di%ensions (Mai%an et al.! 19>>). The %odel continued to evolve into the 19" s! largely at the hands of Marshall Bec(er at 9ohns Hop(ins Aniversity and later at the Aniversity of Michigan -chool. The Health Belief Model relates largely to the cognitive factors predisposing a person to a health behavior! concluding $ith a belief in one#s self2efficacy for the behavior. The %odel leaves %uch still to be e0plained by factors enabling and reinforcing one#s behavior! and these factors beco%e increasingly i%portant $hen the %odel is used to e0plain and predict %ore co%ple0 lifestyle behaviors that needs to be %aintained over a lifeti%e. 1 syste%atic! *uantitative revie$ of studies that had applied the Health Belief Model a%ong adults into the late 19" s found it lac(ing in consistent predictive po$er for %any behaviors! probably because its scope is li%ited to predisposing factors (Harrison! Mullen! and 3reen! 199?). One study that specifically co%pared its predictive po$er $ith other %odels found that it accounted for a s%aller proportion of the variance in diet! e0ercise! and s%o(ing behaviors than did the theory of reasoned action! theory of planned behavior! and the ':5.5C52':O.55C %odel (Mullen! Hersey! and +verson! 19">). Fevertheless! the health belief %odel continued to be the %ost fre*uently applied %odel in published descriptions of progra%s and studies in health education and health behavior in the

early 199 s. +t has since been displaced in fre*uency of application by the transtheoretical %odel of stages of change. +t re%ains! ho$ever! a valuable guide to practitioners in planning the co%%unication co%ponent of health education progra%s. D18:5F.5 8. 3:55F (-55 1D-O& 'ehavioral (hange) 'ehavioral *eterminants) Health +oals) Health utcomes) ,-!(!*!.,- (!!* %odel) ,sychology, Health) Theory of ,lanned 'ehavior) Theory of -easoned /ction) Transtheoretical %odel of 0tages of (hange)

BIB"I#$R%PH&
Bec(er! M. H.! ed. (19>H). GThe Health Belief Model and 'ersonal Health Behavior.G Health !ducation %onographs ?&@?HIH>@. 3lan/! 4.E De$is! 7. M.E and :i%er! B. 4. (199>). GDin(ing Theory! :esearch! and 'ractice.G +n Health 'ehavior and Health !ducation1 Theory, -esearch, and ,ractice, eds. 4. 3lan/! 7. M. De$is! and B. 4. :i%er. -an 7rancisco& 9ossey2Bass. Harrison! 9. 1.E Mullen! '. C.E and 3reen! D. 8. (199?). G1 Meta21nalysis of -tudies of the Health Belief Model.G Health !ducation -esearch >&1 >I11;. Hochbau%! 3. (195;). G8hy 'eople -ee( Ciagnostic B2rays.G ,ublic Health -eports >1&@>>I@" . 9an/! F. 4.! and Bec(er! M. H. (19"H). GThe Health Belief Model& 1 Cecade Dater.G Health !ducation &uarterly 11&1IH>. Mai%an! D. 1.E Bec(er! 1. M.E 4irscht! 9. '. et al. (19>>). G-cales for Measuring Health Belief Model Ci%ensions& 1 Test of 'redictive 6alue! +nternal .onsistency and :elationships a%ong Beliefs.G Health !ducation %onographs 5&?15I?@ . Mullen! '. C.E Hersey! 9.E and +verson! C. .. (19">). GHealth Behavior Models .o%pared.G 0ocial 0cience and %edicine ?H&9>@I9"1. :osenstoc(! +. M. (19;;). G8hy 'eople Ase Health -ervices.G %ilbank %emorial $und &uarterly HH&9HI1?H. -trecher! 6. 9.! and :osenstoc(! +. M. (199>). GThe Health Belief Model.G +n Health 'ehavior and Health !ducation1 Theory, -esearch, and ,ractice, eds. 4. 3lan/! 7. M. De$is! and B. 4. :i%er. -an 7rancisco& 9ossey2Bass.

'heory of reasoned action

7ro% 8i(ipedia! the free encyclopedia 9u%p to& navigation! search

The theory of reasoned action (T:1)! developed by Martin 7ishbein and +ce( 1,/en (19>5! 19" )! derived fro% previous research that started out as the theory of attitude! $hich led to the study of attitude and behavior. The theory $as Gborn largely out of frustration $ith traditional attitude2behavior research! %uch of $hich found $ea( correlations bet$een attitude %easures and perfor%ance of volitional behaviorsG (Hale! Householder! J 3reene! ? @! p. ?59). The (ey application of the theory of reasoned action is prediction of behavioral intention! spanning predictions of attitude and predictions of behavior. The subse*uent separation of behavioral intention fro% behavior allo$s for e0planation of li%iting factors on attitudinal influence (1,/en! 19" ).

(efinition and e)a*ple

Cerived fro% the social psychology setting! the theory of reasoned action (T:1) $as proposed by 1,/en and 7ishbein (19>5 J 19" ). The co%ponents of T:1 are three general constructs& behavioral intention ('I)! attitude (/)! and sub,ective nor% (02). T:1 suggests that a person#s behavioral intention depends on the person#s attitude about the behavior and sub,ective nor%s ('I K / L 02). +f a person intends to do a behavior then it is li(ely that the person $ill do it. Behavioral intention %easures a person#s relative strength of intention to perfor% a behavior. 1ttitude consists of beliefs about the conse*uences of perfor%ing the behavior %ultiplied by his or her valuation of these conse*uences. -ub,ective nor% is seen as a co%bination of perceived e0pectations fro% relevant individuals or groups along $ith intentions to co%ply $ith these e0pectations. +n other $ords! Gthe person#s perception that %ost people $ho are i%portant to hi% or her thin( he should or should not perfor% the behavior in *uestionG (1,/en and 7ishbein! 19>5). To put the definition into si%ple ter%s& a person#s volitional (voluntary) behavior is predicted by his)her attitude to$ard that behavior and ho$ he)she thin(s other people $ould vie$ the% if they perfor%ed the behavior. 1 person#s attitude! co%bined $ith sub,ective nor%s! for%s his)her behavioral intention. 7ishbein and 1,/en say! though! that attitudes and nor%s are not $eighted e*ually in predicting behavior. G+ndeed! depending on the individual and the situation! these factors %ight be very different effects on behavioral intentionE thus a $eight is associated $ith each of these factors in the predictive for%ula of the theory. 7or e0a%ple! you %ight be the (ind of person $ho cares little for $hat others thin(. +f this is the case! the sub,ective nor%s $ould carry little $eight in predicting your behaviorG (Miller! ? 5! p. 1?>). Miller (? 5) defines each of the three co%ponents of the theory as follo$s and uses the e0a%ple of e%bar(ing on a ne$ e0ercise progra% to illustrate the theory&

%ttitudes& the su% of beliefs about a particular behavior $eighted by evaluations of these beliefs o Mou %ight have the beliefs that e0ercise is good for your health! that e0ercise %a(es you loo( good! that e0ercise ta(es too %uch ti%e! and that e0ercise is unco%fortable. 5ach of these beliefs can be $eighted (e.g.! health issues %ight be %ore i%portant to you than issues of ti%e and co%fort).

Sub+ective nor*s& loo(s at the influence of people in one#s social environ%ent on his)her behavioral intentionsE the beliefs of people! $eighted by the i%portance one attributes to each of their opinions! $ill influence one#s behavioral intention
o

Mou %ight have so%e friends $ho are avid e0ercisers and constantly encourage you to ,oin the%. Ho$ever! your spouse %ight prefer a %ore sedentary lifestyle and scoff at those $ho $or( out. The beliefs of these people! $eighted by the i%portance you attribute to each of their opinions! $ill influence your behavioral intention to e0ercise! $hich $ill lead to your behavior to e0ercise or not e0ercise.

Behavioral intention& a function of both attitudes to$ard a behavior and sub,ective nor%s to$ard that behavior! $hich has been found to predict actual behavior.
o

Mour attitudes about e0ercise co%bined $ith the sub,ective nor%s about e0ercise! each $ith their o$n $eight! $ill lead you to your intention to e0ercise (or not)! $hich $ill then lead to your actual behavior.

[edit] ,tility
The theory of reasoned action has Greceived considerable and! for the %ost part! ,ustifiable attention $ithin the field of consu%er behavior...not only does the %odel appear to predict consu%er intentions and behavior *uite $ell! it also provides a relatively si%ple basis for identifying $here and ho$ to target consu%ers# behavioral change atte%ptsG (-heppard! Hart$ic(! J 8arsha$! 19""! p. @?5). Hale et al. (? @) say the T:1 has been tested in nu%erous studies across %any areas including dieting (-e,$ac/! 1,/en! J 7ishbein! 19" )! using condo%s (3reene! Hale! J :ubin! 199>)! consu%ing genetically engineered foods (-par(s! -hepherd! J 7re$er! 1995)! and li%iting sun e0posure (Hoff%an! 1999).

[edit] -or*ula
+n its si%plest for%! the T:1 can be e0pressed as the follo$ing e*uation& 'I K (/')31 L (02)3? $here&

'I K behavioral intention (/') K one#s attitude to$ard perfor%ing the behavior 3 K e%pirically derived $eights 02 K one#s sub,ective nor% related to perfor%ing the behavior @)

(-ource& Hale! ?

[edit] Process

1s a behavioral process! an e0panded T:1 flo$ %odel can be e0pressed as follo$s& Belief to$ard an outco%e 5valuation of the outco%e 1ttitude Beliefs of $hat others thin( 1ttitude Behavior 8hat e0perts thin( -ub,ective nor% Motivation to co%ply $ith others -ource& 1,/en! 19"

[edit] "i*itations and e)tensions

-heppard et al. (19"") disagreed $ith the theory but %ade certain e0ceptions for certain situations $hen they say Ga behavioral intention %easure $ill predict the perfor%ance of any voluntary act! unless intent changes prior to perfor%ance or unless the intention %easure does not correspond to the behavioral criterion in ter%s of action! target! conte0t! ti%e2fra%e and)or specificityG (p. @?5). -o! in reference to the above e0a%ple! if prior to your e0ercising you learn you have a %edical condition! this %ay affect your behavioral intention. -heppard et al. (19"") say there are three li%iting conditions on 1) the use of attitudes and sub,ective nor%s to predict intentions and ?) the use of intentions to predict the perfor%ance of behavior. They are& 1. $oals .ersus Behaviors& distinction bet$een a goal intention (an ulti%ate acco%plish%ent such as losing 1 pounds) and a behavioral intention (ta(ing a diet pill) ?. 'he Choice %*on/ %lternatives& the presence of choice %ay dra%atically change the nature of the intention for%ation process and the role of intentions in the perfor%ance of behavior @. Intentions .ersus 0sti*ates& there are clearly ti%es $hen $hat one intends to do and $hat one actually e0pects to do are *uite different -heppard et al. (19"") suggest Gthat %ore than half of the research to date that has utili/ed the %odel has investigated activities for $hich the %odel $as not originally intendedG (p. @@"). Their e0pectation $as that the %odel $ould not fare $ell in such situations. Ho$ever! they found the %odel Gperfor%ed e0tre%ely $ell in the prediction of goals and in the prediction of activities involving an e0plicit choice a%ong alternatives.G Thus! -heppard et al. (19"") concluded that the %odel Ghas strong predictive utility! even $hen utili/ed to investigate situations and activities that do not fall $ithin the boundary conditions originally specified for the %odel. That is not to say! ho$ever! that further %odifications and refine%ents are unnecessary! especially $hen the %odel is e0tended to goal and choice do%ainsG (p. @@"). Hale et al. (? @) also account for certain e0ceptions to the theory $hen they say GThe ai% of the T:1 is to e0plain volitional behaviors. +ts e0planatory scope e0cludes a $ide range of behaviors such as those that are spontaneous! i%pulsive! habitual! the result of cravings! or si%ply scripted or %indless (Bentler J -pec(art! 19>9E Danger! 19"9). -uch behaviors are e0cluded because their perfor%ance %ight not be voluntary or because engaging in the behaviors %ight not involve a conscious decision on the part of the actorG (p. ?5 ).

[edit] 'heory revision

The theory has even been revised and e0tended by 1,/en hi%self into the theory of planned behavior. GThis e0tension involves the addition of one %a,or predictor! perceived behavioral control! to the %odel. This addition $as %ade to account for ti%es $hen people have the intention of carrying out a behavior! but the actual behavior is th$arted because they lac( confidence or control over behaviorG (Miller! ? 5! p. 1?>). 1,/en#s revised conceptual %odel! accounting for actual behavioral control! can be e0pressed as follo$s& Behavioral Beliefs 1ttitude To$ard the Behavior For%ative Beliefs -ub,ective For% .ontrol Beliefs 'erceived Behavioral .ontrol 1ctual Behavioral .ontrol (-ource& 1,/en! 1991) +ntention Behavior

[edit] See also

Theory of planned behavior Technology acceptance %odel Behavioural change theories (overvie$ article)

[edit] References

1,/en! +.! J 7ishbein! M. (19" ). 4nderstanding attitudes and predicting social behavior. 5ngle$ood .liffs! F9& 'rentice2Hall. 7ishbein! M.! J 1,/en! +. (19>5). 'elief, attitude, intention, and behavior1 /n introduction to theory and research. :eading! M1& 1ddison28esley.<1= Hale! 9.D.! Householder! B.9.! J 3reene! 4.D. (? @). The theory of reasoned action. +n 9.'. Cillard J M. 'fau (5ds.)! The persuasion handbook1 *evelopments in theory and practice (pp. ?59I?";). Thousand Oa(s! .1& -age. Miller! 4. (? 5). (ommunications theories1 perspectives, processes, and conte5ts. Fe$ Mor(& Mc3ra$2Hill. -heppard! B.H.! Hart$ic(! 9.! J 8arsha$! '.: (19""). The theory of reasoned action& 1 %eta2analysis of past research $ith reco%%endations for %odifications and future research. 6ournal of (onsumer -esearch! 15! @?5I@H@.

%+1en2 I3 4566573 'he theory of planned behavior3 #r/ani1ational Behavior and Hu*IC08 %9:0;

Sub+ect Psycholo/y (#I< 5=35555>b36?@=AB5C=C@663566A3)

0)tract
The theory of reasoned action $as developed in the conte0t of research on the relation bet$een attitudes and behavior ( 1,/en J 7ishbein! 19" ). -uitable for the prediction of volitional actions! the theory posits that intentions are the i%%ediate antecedents of behavior and that these intentions arc deter%ined by attitudes to$ard the behavior and by sub,ective nor%s. The attitude is the tendency to evaluate perfor%ance of the behavior favorably or unfavorably and the sub,ective nor% represents the perceived social pressure to engage in the behavior. The theory of reasoned action has been used successfully to predict behaviors in a $ide range of situations! and to develop progra%s of intervention designed to %odify undesirable patterns of behavior. 8hen dealing $ith activities that are largely under volitional control! intentions are predictive of actual behavior! and they correlate $ell $ith attitudes and sub,ective nor%s. 1%ong the %any behaviors studied are cigarette s%o(ing! fa%ily planning! dental care! $ater conservation! condo% use! recycling! charitable behavior! fat consu%ption! physical e0ercise! cancer self2e0a%ination! outdoor recreation! television vie$ing! living (idney donation! and seat2belt use. -ee also& attitudes and behavior . ( 19" ). Anderstanding attitudes and predicting social behavior . 5ngle$ood .liffs ! F9 & 'rentice Hall .

an Cecision 'rocesses! 5 ! p. 1>9I?11.

'heory of Reasoned %ction

The theory of reasoned action (T:1) $as developed by Martin 7ishbein and +ce( 1,/en in 19>5 to e0a%ine the relationship bet$een attitudes and behavior. T:1 loo(s at behavioral intentions rather than attitudes as the %ain predictors of behavior. 1ccording to this theory! attitudes to$ard a behavior (or %ore precisely! attitudes to$ard the e0pected outco%e or result of a behavior) and sub,ective nor%s (the influence other people have on a person#s attitudes and behavior) are the %a,or predictors of behavioral intention. T:1 $or(s %ost successfully $hen applied to behaviors that are under a person#s volitional control. The health2education i%plications of this theory allo$ one to identify ho$ and $here to target strategies for changing behavior (e.g.! prevention of se0ually2trans%itted diseases and health fitness behaviors). COF1DC 5. MO:+-4M

Behavioral Chan/e

Many behaviors are related to health and health ris(s. Anprotected se0ual intercourse! for e0a%ple! is a behavior that puts one at ris( for H+6 (hu%an i%%unodeficiency virus) and other se0ually trans%itted infections. -i%ilarly! %aintaining an unhealthful diet is a behavior that puts one at ris( for cardiovascular disease. Many health pro%otion interventions see( to turn people a$ay fro% ris(y behaviors and to$ard healthful behaviors! such as using condo%s $hen having se0ual intercourse and follo$ing a diet rich in fruits and vegetables. Behavior change is a co%ple0 process. 'ositive health2related changes co%e about $hen people learn about ris(s and $ays of enhancing health! and $hen they develop positive attitudes! social support! self2efficacy! and behavioral s(ills. Health2pro%oting behaviors are %ost usefully defined as perfor%ance ob,ectives. 7or e0a%ple! safe se0ual practices are enhanced by practical ob,ectives& purchasing condo%s! carrying condo%s! negotiating condo%s! correctly applying condo%s! and %aintaining condo% use. 35:9O 4O4

Social Co/nitive 'heory

The self2%anage%ent of health re*uires develop%ent of self2regulatory s(ills. This is achieved through self2regulatory subfunctions that provide guides and %otivators for self2 directed change. 'eople have to (eep trac( of their health habits. -elf2%onitoring provides the infor%ation needed for setting realistic goals and for evaluating one#s progress to$ard the%. 'eople %otivate the%selves and guide their behavior by the goals and challenges they set for the%selves. 3oals %otivate by enlisting self2evaluative involve%ent in the activity. The evaluative self2reactions provide the %eans by $hich personal standards regulate courses of action.

P0RS#;%" 0--IC%C&
The self2%anage%ent syste% operating through self2%onitoring! goal setting! and self2 reactive influence is rooted in beliefs of personal efficacy. This core belief syste% is the foundation of hu%an %otivation and action. Anless people believe they can produce desired effects by their actions! they have little incentive to act or to persevere in the face of difficulties. +n social cognitive theory! perceived efficacy is a (ey deter%inant because it affects lifestyle habits both directly and by its influence on other deter%inants. The stronger the perceived efficacy! the higher the goals people set for the%selves! the %ore they e0pect their efforts to produce desired outco%es! and the %ore they vie$ obstacles and i%pedi%ents to personal change as sur%ountable. Cevelop%ent of self2regulatory capabilities re*uires instilling a resilient sense of efficacy as $ell as i%parting s(ills. 50periences in e0ercising control over troubleso%e situations serve as efficacy builders. +f people are not convinced of their personal efficacy! they rapidly abandon the s(ills they have been taught $hen they fail to get *uic( results or suffer reverses. 5fficacy beliefs affect every phase of personal change& $hether people even consider changing their health habitsE $hether they enlist the %otivation and perseverance needed to succeedE their facility to recover fro% setbac(sE and ho$ $ell they %aintain the habit changes

they have achieved. The self2efficacy belief syste% operates as a co%%on %echanis% through $hich psychosocial treat%ents affect different types of health outco%es.

P,B"IC H0%"'H %PP"IC%'I#;S

'eople see little point in even trying if they believe they do not have $hat it ta(es to succeed. +n co%%unity2$ide health ca%paigns! people#s pree0isting efficacy beliefs and the efficacy beliefs instilled by the ca%paign contribute to adoption of health pro%oting habits. This calls for a change in e%phasis fro% trying to scare people into health to enabling the% to achieve self2directed change. 5ffective self2%anage%ent %odels infor% people of the health ris(s and benefits of different lifestyles habitsE create the self2regulatory s(ills needed to translate infor%ed concerns into health pro%otive actionsE build a resilient sense of efficacy to support control in the face of difficultiesE and enlist social supports for desired personal changes. The guiding principles! i%ple%entative practices! and e%pirical docu%entation of effectiveness are revie$ed in so%e detail in 0elf.!fficacy1 The !5ercise of (ontrol (Bandura! 199>). By co%bining the high individuali/ation of the clinical approach $ith the large2scale applicability of the public health approach! health self2%anage%ent syste%s ensure high social utility. +t is easier to prevent detri%ental health habits than to try to change the% after they have beco%e deeply entrenched as part of a lifestyle. The social cognitive %odel provides a valuable public health tool for societal efforts to pro%ote the health of its youth. 'reventive progra%s often produce $ea( results because they are heavy on didactics but %eager on personal enable%ent. Health (no$ledge can be conveyed readily! but changes in values! attitudes! and health habits re*uire greater effort. Health pro%otion progra%s that enco%pass the essential ele%ents of the self2regulatory %odel achieve greater success. The *uality of health of a nation is a social %atter! not ,ust a personal one. +t re*uires changing the practices of social syste%s that i%pair health rather than ,ust changing the habits of individuals. 'eople#s beliefs in their collective efficacy to acco%plish social change by perseverant group action play a (ey role in the policy and public health approach to health pro%otion. 3iven that health is heavily influenced by behavioral! environ%ental! and econo%ic factors! health pro%otion re*uires e%phasis on the develop%ent and enlist%ent of collective efficacy for socially oriented initiatives. 1DB5:T B1FCA:1