PRESENTED BY

AMRITA CHHABRA

 BETTY NEUMAN MODEL

JEAN WATSONS THEORY OF HUMAN CARING

KINGS THEORY OF GOAL ATTAINMENT
SISTER CALLISTA ROYS ADAPTATION MODEL
HEALTH BELIEF MODEL
HEATH PROMOTION MODEL

Developed in 1970 at the University of California, Los

Angeles, by Betty Neuman.

The model was developed to teach an introductory nursing

course to nursing students.

Goal was to provide a holistic overview of the physiological,

psychological, socio-cultural, and developmental aspects of
human beings.

After a two-year evaluation of the model, it was published in

Nursing Research (Neuman & Young, 1972).

The Model
The Neumans System Model provides a comprehensive, flexible,

holistic, and systems-based perspective for nursing. This conceptual

model of nursing focuses attention on the response of the client
system to actual or potential environment stressors, and the use of
primary, secondary, and tertiary nursing prevention interventions
for retention, attainment, and maintenance of optimal client system
wellness.
- Betty Neuman (1996)

THE SYSTEM MODEL

This

model

is

conceptual

framework,

visual

representation, for thinking about humans and nurses and

their interactions.
Views the person as a layered, multidimensional whole that
is in constant dynamic interaction with the environment.

The layers represent various levels of defense protecting the

core being.
The two major components in the model are stress reactions

and systemic feedback loops.

Client reacts to stress with lines of defense and resistance
(Neuman, 1995).

THE SYSTEM MODEL

The client is in continuous and dynamic interaction with the
environment. The exchanges between the environment and the
client are reciprocal (each one is influenced by the other).
The goal is to achieve optimal system stability and balance.
Prevention is the main nursing intervention to achieve this
balance.
Primary, secondary, and tertiary prevention activities are used to

attain, retain, and maintain system balance (George, 1996).

Person variables
Each layer, or concentric circle, of the Neuman model is
made up of the five person variables. Ideally, each of the
person variables should be considered simultaneously
and comprehensively.
Physiological - refers of the physicochemical structure and
function of the body.
Psychological - refers to mental processes and emotions.
Sociocultural - refers to relationships; and social/cultural

expectations and activities.

Spiritual - refers to the influence of spiritual beliefs.
Developmental

refers

to

development over the lifespan.

those

processes

related

to

Central Core
The basic structure, or central core, is made up of the basic survival factors
that are common to the species (Neuman, 1995, in George, 1996).
These factors include: system variables, genetic features, and the

strengths and weaknesses of the system parts.

Examples of these may include: hair color, body temperature regulation

ability, functioning of body systems homeostatically, cognitive ability,
physical strength, and value systems.
The person's system is dynamic and constantly changing and evolving.
Stability, or homeostasis, occurs when the amount of energy that is available
exceeds that being used by the system.
A homeostatic body system is constantly in a dynamic process of input,
output, feedback, and compensation, which leads to a state of balance.

Flexible Lines of Defense

The flexible line of defense is the outer barrier or cushion to the
normal line of defense, the line of resistance, and the core structure.
If the flexible line of defense fails to provide adequate
protection to the normal line of defensethe lines of
resistance become activated.

The flexible line of defense acts as a cushion and is described as

accordion-like as it expands away from or contracts closer to the
normal line of defense.

The flexible line of defense is dynamic and can be changed/ altered

in a relatively short period of time.

Normal Line of Defense

The normal line of defense represents system
stability over time.
It is considered to be the usual level of stability in
the system.
The normal line of defense can change over time
in response to coping or responding to the
environment.
An example is skin, which is stable and fairly
constant, but can thicken into a callus over time.

Lines of Resistance
The lines of resistance protect the basic structure and

become activated when environmental stressors

invade the normal line of defense.
Example: activation of the immune response
after invasion of microorganisms.
If the lines of resistance are effective, the system can

reconstitute and if the lines of resistance are not

effective, the resulting energy loss can result in death.

Reconstitution
Reconstitution is the increase in energy that
occurs in relation to the degree of reaction to the
stressor.
Reconstitution begins at any point following
initiation of treatment for invasion of stressors.
Reconstitution may expand the normal line of
defense beyond its previous level, stabilize the
system at a lower level, or return it to the level
that existed before the illness.

Stressors
The Neuman Systems Model looks at the impact of stressors on
health and addresses stress and the reduction of stress (in the

form of stressors).
A stressor is any environmental force which can potentially
affect the stability of the system: they may be:
Intrapersonal - occur within person,
e.g. emotions and feelings
Interpersonal
occur
between
individuals, e.g. role expectations
Extra personal - occur outside the
individual, e.g. job or finance pressures

 The person has a certain degree of reaction to

any given stressor at any given time.
The nature of the reaction depends in part on
the strength of the lines of resistance and
defense.

PREVENTION
Prevention is the primary nursing intervention.
Prevention focuses on keeping stressors and the stress response
from having a detrimental effect on the body.

Primary
Primary prevention occurs before the system reacts to a
stressor. Primary prevention includes health promotion
and maintenance of wellness.

Secondary
Secondary prevention occurs after the system reacts
to a stressor and is provided in terms of existing
systems.

Tertiary
Tertiary prevention occurs after the system has
been treated through secondary prevention
strategies.

META PARADIGM
PERSON
The person is a layered multidimensional being. Each layer
consists of five person variables or subsystems:
Physical/P
hysiological
Development
al

Spiritual

Psychological

Sociocultural

Contd
The layers, usually represented by concentric circle, consist of the central
core, lines of resistance, lines of normal defense, and lines of flexible
defense.

The basic core structure is comprised of survival mechanisms including:

organ function, temperature control, genetic structure, response patterns,
ego, and what Neuman terms knowns and commonalities.
Lines of resistance and two lines of defense protect this core.
The person, with a core of basic structures, is seen as being in constant,
dynamic interaction with the environment.
The person is seen as being in a state of constant change and-as an open
system-in reciprocal interaction with the environment (i.e. affecting, and
being affected by it).

Contd

ENVIRONMENT

The environment is the totality of the internal and external forces

which surround a person and with which they interact at any given
time.
These

forces

include

the

intrapersonal,

interpersonal

and

extrapersonal stressors which can affect the person's normal line of

defense and so can affect the stability of the system.

The internal environment exists within the client system.
The external environment exists outside the client

system.
Neuman also identified a created environment which is an
environment that is created and developed unconsciously by the client

and is symbolic of system wholeness.

HEALTH

Contd

Neuman sees health as being equated with wellness.

She defines health/wellness as "the condition in which all parts and
subparts (variables) are in harmony with the whole of the client
(Neuman, 1995)".
As the person is in a constant interaction with the environment, the state of
wellness (and by implication any other state) is in dynamic equilibrium,

rather than in any kind of steady state.

Neuman proposes a wellness-illness continuum, with the person's position
on that continuum being influenced by their interaction with the variables
and the stressors they encounter.
The client system moves toward illness and death when more energy
is needed than is available.
The client system moves toward wellness when more energy is
available than is needed.

Contd
NURSING
Neuman sees nursing as a unique profession that is concerned with

all of the variables which influence the response a person might

have to a stressor.
Neuman defines nursing as actions which assist individuals,
families and groups to maintain a maximum level of wellness, and
the primary aim is stability of the patient/client system, through
nursing interventions to reduce stressors.
The role of the nurse is seen in terms of degrees of reaction to
stressors, and the use of primary, secondary and tertiary
interventions.

INTRODUCTION OF THE THEORIST

Jean Watson was born in a town of West Virginia in the 1940s.
Jean Watson graduated from the Lewis Gale School of Nursing in
Roanoke, Virginia, in 1961.
Earned a B.S. in 1964, an M.S. in psychiatric and mental health
nursing in 1966, and a Ph.D. in educational psychology and counseling

in 1973 at University of Colorado at Boulder.

She is the author of numerous books, including The Philosophy and
Science of Caring.
She currently (2010) holds an endowed chair at the University of
Colorado .
She created the non-profit Watson Caring Science Institute in 2008 to
further spread her ideas.

DEVELOPMENT OF THE THEORY

The theory of human caring was developed between
1975 and 1979, while Watson was teaching at
University of Colorado.
Influenced by her own views about nursing
Eastern Philosophy: focuses on a holistic approach,
looking at the body as a whole unit, not a sum of parts
This links to earlier nursing theorists, including:

Nightingale, Leininger
Psychology theorists who influenced her theory of
caring: Hans Selye, Carl Rogers

Three major concepts of her theory:

Ten Carative Factors

The Caring Occasion / The Caring

Moment
Transpersonal Caring

Carative Factors
Caritas comes from the Latin word meaning to

cherish, to appreciate, to give special attention.

Invites nurse to explore the intersection

between personal and professional

The Ten Carative Factors:

1. The formation of a Humanisticaltruistic(showing unselfish concern for the

welfare of others) system of values.

Carative factors contd..

2. The instillation of faith-hope.

3. The cultivation of sensitivity to self and to others.

4. The development of helping-trusting human care

relationships.
5. The promotion and acceptance of expression of
positive and negative feelings.
6. The systematic use of scientific problem solving
method for decision making.

Carative factors contd..

7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and (or)
corrective mental, physical, societal and spiritual

environment.
9. Assistance with the gratification of Human needs.
10. The allowance for Existential-phenomenologicalspiritual forces.

WATSONS ORDERING OF NEEDS

ORDER

1.

Lower Order Needs ( Biophysical Needs)

The need for food and fluid
The need for elimination
The need for ventilation

TYPE OF
NEEDS

Survival Needs

2. Lower Order Needs (Psychophysical Needs)

The need for activity- inactivity
The need for sexuality

Functional Needs

3. Higher Order Needs ( Psychosocial Needs)

The need for achievement
The need for affiliation

Integrative Needs

4. Higher Order Needs (Intrapersonal

Interpersonal Need)
The need for self actualization

Growth Seeking
Needs

Concepts contd
Transpersonal Caring Relationship
Foundation of the work
Shows concern for inner life world of another fully
embodied person
Goes beyond ego self, reaching to the deeper connections to
spirit & broader universe
Nurse uses caring consciousness to preserve & honor
embodied spirit & heal as experience, perception, and

intentional connection take place

Be an authentic being, in the moment
(Watson, 2007)

Concepts contd..
Caring Occasion - Caring Moment
Occurs when nurse & another come together
with unique life histories & phenomenal
fields in a human-to-human transaction

Transcendent: experience & perception take

place = greater field potentiated
Involves action & choice by both participants

Becomes part of life history of each person

as well as stamp on history of time
(Watson, 2007)

PROPOSITIONS - DIAGRAM

METAPARADIGMS OF
WATSONS THEORY

PERSON (PATIENT)
Is subjective and unique, not objective,
predictable and calculating.
Has distinct human needs, which are
biophysical, psychophysical, psychosocial
and interpersonal.

Is to be valued, cared for, respected,

nurtured, understood and assisted.
Is a functioning whole, there is no division

among the mind, body and spirit

Is directly influenced by their external
environment.

ENVIRONMENT
Is crucial to the holistic healing (mental, physical, social,
emotional,

spiritual,

developmental,

protective,

supportive

environments), which is conducive to a patients health and

wellbeing
Society provides value how one should behave and what goals one
should strive towards
Change in social, cultural and spiritual arenas can cause stress to
a person
Each person has need to love and to be loved
So nurse need to meet a persons caring needs when he is in stress.

HEALTH
Is viewed holistically, as the unity
between the physical, social, mental

and

spiritual

self,

with

all

parts

working together in harmony and

functioning to their full capacity.

Is a perceived by the patient and is

influenced by their own unique life
experiences .
Medical care is different from health
care as true health care focus on
lifestyle,

social

environment.

conditions

and

NURSING
Is a caring, meaningful and
harmonic connective bond that is
shared between the nurse and the
patient.
Is providing care, professional
and thoughtful interactions to
restore and promote holistic
health and to prevent illness.
Is a holistic practice that is
complementary to medicine.

Theory of Goal Attainment

EDUCATIONAL BACKGROUND
1945 Nursing diploma from St. Johns Hospital of Nursing, St. Louis,
Missouri

1948 BS Nursing & Education with minors in philosophy &

chemistry from St. Louis University, St. Louis, Missouri
1957 MS Nursing from St. Johns University
1961 Ed.D. from Teachers College, Columbia University
1980 Honorary Ph. D from Southern Illinois University
Postdoctoral study in research design, statistics and computer

WORK EXPERIENCES
Administrator (Ohio State University)
Educator (St. Johns Hospital School of Nursing; Loyola
University; University of South Florida)

Practitioner (Adult Medical-Surgical Nursing)

Assistant chief of the Research Grants Branch, Division
of Nursing, Department of Health, Education and Welfare

Professor emeritus at University of South Florida

ACHIEVEMENTS
Founder of King International Nursing
Group (KING) (1998)
Jessie M. Scott award (ANA convention)
Award presented to a registered nurse whose
accomplishments in a field of practice, education,
or research with significance for the improvement
of nursing and health care.

HER STORY
1963.. challenged by her philosophy
professors with a question, Have you or any
other nurses defined the nursing act?
1972.. reading course work led King to the
Literature Systems analysis and General
Systems Theory and hence to another set of
questions

Kings Theory and Nursings

Metaparadigm

PERSON
social beings who are rational
and sentient
communicate their thoughts,
actions, customs, and beliefs
through language
exhibit common characteristics
like ability to perceive, to think, to
feel, to choose between alternative
courses of action, to set goals, to
select means to achieve goals, and
to make decisions

NURSING
a process of action,
reaction, and interaction
whereby nurse and client
share information about
their perceptions in the
nursing situation
nurse and patient share
goals, problems, and
concerns and explore
means to achieve a goal.

NURSING
Goal of nurse: To help
individuals to maintain their
health so they can function in
their roles.
Domain of nurse: Includes
promoting, maintaining, and
restoring health, and caring for
the sick, injured and dying.
Function of professional
nurse: To interpret information
in nursing process to plan,
implement and evaluate nursing
care.

NURSING
ACTION
Mental
Action

Recognize
the
presenting
conditions.

Physical
Action

Mental
Action

Physical
Action

Begin
activities
related to
those
conditions.

Effort to
exert
control
over the
situation.

Seeking
to
achieve
goals.

HEALTH
dynamic life experience of a human being
which implies continuous adjustment to
stressors in the external and internal
environment through optimum use of ones
resources to achieve maximum potential for daily
living.
She discusses health as a functional state and
illness as an interference with that functional
state.

ENVIRONMENT
the background for human actions

Environment and Society are indicated as major concepts in Kings

conceptual system but are not specifically defined in her work.

Society may be viewed as the social systems portion of her

conceptual system.

Although Kings definition of health mentions both internal and

external environments, King also stated that environment is a
function of balance between internal and external interactions.

ENVIRONMENT
Internal environment:
transforms energy to
enable person to adjust to
continuous
external
environmental changes
External environment:
involves
formal
and
informal organizations.
Nurse is a part of the
patients environment.

DYNAMIC INTERACTING SYSTEMS/ Kings open

systems framework

Three
systems
in
conceptual framework:

the

Personal System (the individual)

Interpersonal
Systems
(individuals interacting with one
another)
Social System (groups of people in
a
community/society
sharing
common goals, interests, and values)

Study systems as a whole

rather than as isolated parts of
a system.

Contd.

Elements of each System

Goal: Health.
Structure: 3 open systems.
Functions:

identified in the reciprocal

relationships as they interact.

Resources: essential to keep systems in
harmony
People, money, goods and items needed to
carry out specific activities.

Decision making: occurs when choices

are made in resource allocation to attain

goals.

Personal System Concepts

Perception; A process in which data obtained through the senses and from memory are
organized, interpreted and transformed.

Self; Awareness of being a person separate from others.

Growth and Development; cellular, molecular and behavioral changes in human
beings.

Body Image; Personal & subjective; acquired or learned; dynamic and changing. Includes how
person sees self & others reactions to ones appearance.

Space; Exist in all directions, is the same everywhere, and is defined by the physical area
known as territory and by the behaviors of those who occupy it.

Time; A duration between one event and another as uniquely experienced by each human
being.

Learning (1986, not defined)

Interpersonal System Concepts

Interaction; Observable behaviors of two or more persons in mutual presence.
Communication; A process whereby information is given from one person to
another either directly in face to face meeting or indirectly through telephone,
television or the written word.

Transactions; A process of interactions in which human beings communicate

with the environment to achieve goals that are valued.

Role; Nurses role is interacting with one or more others in a nursing situation to
identify goals and help others to achieve the goals.

Stress; A dynamic state whereby a human being interacts with the

environment to maintain balance for growth, development and

performance.

Social System Concepts

Organization; Made up of persons with roles and positions who
make use of resources to meet both personal and organizational goals.

Authority; Active reciprocal process of regularity, direction and

responsibility for actions.

Power; Capacity to use resources in organizations to achieve goals.

Status; The position of an individual in a group or a group in relation to other
groups in an organization.

Decision Making; A dynamic and systematic process by which goaldirected choice of perceived alternatives is made and acted upon by individuals
or groups to attain a goal.

THEORY OF GOAL ATTAINMENT

elements are seen in the interpersonal systems in which two people, who

are usually strangers, come together in a health care organization to help

and be helped to maintain a state of health that permits functioning of roles.

reflects Kings belief that the practice of nursing is differentiated from

other healthcare professions by what nurses do with and for
individuals.

Nurse and client communicate information, set goal mutually and then
act to attain those goals

MAJOR CONCEPTS OF THE THEORY

Interaction
Process of perception and communication
between person and environment and between
person and person.
Represented by verbal or non-verbal behaviors
that seek to reach goals.

KINGS DIAGRAM OF INTERACTION

Feedbac
k
Nurse

Perception
Judgment

Action

Reaction
Interaction

Judgment

Patient

Action

Reaction

Perception

Feedbac
k

Transaction

MAJOR CONCEPTS OF THE THEORY

(contd)
Perception
Reality as seen by an individual
The elements of perception are the importing of
energy from the environment, Organizing it by
information,
interpreting, and transforming
information from sensory to memory.

MAJOR CONCEPTS OF THE THEORY

(contd)
Communication
Exchange of information between people
(face-to-face, electronic media, written)
May be intrapersonal / interpersonal

MAJOR CONCEPTS OF THE THEORY

(contd)
Transaction
Process of interactions in which human
beings communicate with the environment to
achieve goals that are valued.
Goal-directed human behaviors.
Mutual goal setting.

MAJOR CONCEPTS OF THE THEORY

(contd)
Role
Set of expected behaviors occupying a Position
in a social system.
Rules that define Rights and responsibilities.
Relationship between individuals interacting in

specific situations for a purpose.

MAJOR CONCEPTS OF THE THEORY

(contd)
Stress
Ever changing condition where an individual interacts with

the

environment

to

maintain

balance

for

growth,

development, and performance.

It is the exchange of information between human and

environment for regulation and control of stressors.

Although stress may be positive or negative, too high a level of

stress may decrease an individuals ability to interact and to attain
goals.

MAJOR CONCEPTS OF THE THEORY

(contd)
Growth and Development
Ever occurring changes in behavior and at the
cellular and molecular level of an individual.
Moves a person from potential capacity for
achievement to self actualization.

MAJOR CONCEPTS OF THE THEORY

(contd)
Time
An interval between two events that is
experienced differently by each person.
The relation of one event to another.

MAJOR CONCEPTS OF THE THEORY

(contd)
Space
Exists in every direction and is the
same in all directions.
Includes that physical area named

territory.
Defined by the behaviors of a person
who occupy it.

Introduction to Theorist
Health Promotion model was developed by Nola
J. Pender in early 1980. Pender was born on
August 16, 1946 in Lansing, Michigan. She
received her nursing diploma in 1962. In 1964,
Pender completed her baccalaureate.

Introduction to Model
The initial version of health
promotion model appeared
in early 1980s and focused
on
health
promoting
behaviors
rather
than
health protection or illness
prevention .

Assumptions:
Persons seek to create conditions of living through which
they can express their unique human health potential.
Persons have the capacity for reflective self-awareness,
including assessment of their own competencies.
Persons value growth in directions viewed as positive and
attempt to achieve a personally acceptable balance
between change and stability.

Cont..
Individuals seek to actively regulate their own
behavior.
Individual in all their biopsychosocial complexity
interact

with

transforming

the

environment,

the

environment

transformed over time.

progressively
and

being

Cont..
Health professionals constitute a part of the
interpersonal

environment,

which

exert

influence on persons throughout their life span.

Self-initiated

reconfiguration

of

person-

environment interactive patterns is essential to

behavior change.

HEALTH PROMOTION MODEL

Model focuses on three areas:

Individual characteristics and experiences
Behavior-specific cognitions and affect
Behavioral outcomes

Cont
Personal

psychological

factors:

Include variables such as self esteem, self

motivation,

personal

competence,

perceived health status and definition of

health.

Personal

socio-cultural

factors:

Include variables such as race, ethnicity,

education and socioeconomic status.

Behavior Specific Cognition and

Affect
It

is

considered

to

be

major

motivational

significance. It constitutes a critical core for

nursing intervention because it can be modified. It
includes following:
Perceived benefits of action:

anticipated

benefits or outcomes (e.g., physical fitness & stress

reduction) affect the persons plan to participate in
health promoting behavior and may continued the
practice.

Cont..
Perceived barriers to action: A
persons perceptions about

available time, inconvenience,

expense, and difficulty in
performing activity may act as

barriers (imagined or real). It affect

the Health promoting Behavior by
decreasing the individual plan of

action.

Cont..
Perceived Self efficacy: Judgment

of personal capability to organize and

execute a health-promoting behavior.
Perceived self efficacy influences

perceived barriers to action so higher

efficacy result in lowered perceptions
of barriers to the performance of the

behavior.

Cont..
Activity related Affect: Subjective positive or
negative feeling that occur before, during and
following behavior based on the stimulus properties
of

the

behavior

itself.

Activity-related

affect

influences perceived self-efficacy, which means the

more positive the subjective feeling, the greater the
feeling of efficacy. In turn, increased feelings of
efficacy can generate further positive affect.

Cont
Interpersonal Influences:
Interpersonal influences are a persons
perceptions concerning the behaviors,
beliefs, or attitudes of others. Family,
peers, and health care providers are the
source of interpersonal influences. It
includes

expectations

of

significant

others, social support, and learning

through observing others.

Cont..
Situational Influences:

are directly or indirectly influences health

promoting behavior and include perception of
available options, demand characteristics, and
the aesthetic features of the environment. E.g a
company regulation

that demands safety

equipment to be worn or that establishes a no

smoking environment

Behavioural Outcome
Health promoting behavior is the outcome of
Health Promotion Model, is directing toward
attaining positive health outcomes for the

client.
Health promoting behavior should results in

improved health, enhanced functional ability,

and better quality of life.

Commitment to a Plan of
Action
It is a concept of commitment and identification
of a planned strategy leads to implementing and
reinforcing the health behavior.

Immediate Competing Demands

and Preferences
Competing demands:

are those alternative

behavior over which individuals
have low control because there

are environmental
contingencies such as work or
family care responsibilities.

Cont..
Competing preferences
are alternative behavior over which
individuals exert relatively high control,
such as choice of ice cream or apple for
a snack.

HEALTH PROMOTION MODEL

INTRODUCTION
History and Orientation

The Health Belief Model (HBM) is a psychological

model that attempts to explain and predict health
behaviors. This is done by focusing on the attitudes
and beliefs of individuals. The HBM was first
developed in the 1950s by social psychologists
Hochbaum, Rosenstock and Kegels working in the
U.S. Public Health Services.

 The model was developed in response to the

failure of a free tuberculosis (TB) health
screening program. Since then, the HBM has
been adapted to explore a variety of long- and

short-term health behaviors, including sexual

risk

behaviors

and

the

transmission

of

HIV/AIDS. The model was furthered by Becker

and colleagues in the 1970s and 1980s.

Originally, the model was designed to predict

behavioral response to the treatment received by
acutely or chronically ill patients, but in more
recent years the model has been used to predict
more general health behaviors.

Becker (1974) modified the health belief model to

include these components:
Individual perceptions
Modifying factors
Variables likely to affect initiating action

INDIVIDUAL PERCEPTIONS
Perceived susceptibility (What are the
chances that this could happen to me?)

A family history of a certain disorder, such as

diabetes or heart disease, may make the

individual feel at high risk.

Cont.
Perceived seriousness - (How serious could it
be if it did happen to me?)
Concern about the spread of acquired immune
deficiency syndrome reflects the general publics
perception of the seriousness of this illness.

Cont.
Perceived threat perceived susceptibility &
perceived seriousness combine to determine the
total perceived threat of an illness to a specific
individual. E.g. a person who perceives that many

individuals in the community have AIDS may not

necessarily perceive a threat of the disease; if the
person is a drug addict or a homosexual, however

the perceived threat of illness is likely to increase

because

of

seriousness

the

combined

susceptibility

&

MODIFYING FACTORS
Demographic variables Age, sex, race ethnicity
etc. eg an infant does not perceive the
importance of healthy diet. An adolescent may

percieve peer approval as more important than

family approval.

MODIFYING FACTORS
Sociopsychological variables social pressure or
influence from peers or other reference groups

may encourage preventive health behaviours

even when individual motivation is low. Eg not

to drive after drinking alchol.

MODIFYING FACTORS
Sociopsychological variables social pressure or
influence from peers or other reference groups

may encourage preventive health behaviours

even when individual motivation is low. Eg not

to drive after drinking alchol.

MODIFYING FACTORS
Structural variables presumed to influence
preventive behavior or knowledge about the

target disease and prior contact with it.

Becker found higher compliance rates with
prescribed treatments among mothers whose
children

had

frequent

occurences of Asthma

ear

infections

&

 Cues to action cues can be either internal or

external. Internal cues includes feeling of
fatigue, uncomfortable symptoms or thoughts
about the condition of an ill person.

Likelihood of action
It depends on the perceived benefits of the
action minus the perceived barriers to the

action.
Perceived benefits of the action - refraining from
smoking to prevent lung cancer, and eating
nutritious foods and avoiding snacks to maintain
weight.

 Perceived barriers to action includes cost,

inconvenience, unpleasantness and lifestyle
changes.

Health Belief Model

(Becker, 1974, 1988; Janz & Becker, 1984)
INDIVIDUAL PERCEPTIONS
ACTION

Perceived Susceptability
to Disease X
Perceived Seriousness
(Severity) of Disease X

Adapted from Janz & Becker (1984).

Health Education Quarterly, 11, 1-47.

MODIFYING FACTORS

LIKELIHOOD OF

Demographic variables
(age, sex, race,
ethnicity, etc.)

Perceived benefits of
preventive action

Sociopsychological variables

Perceived barriers to
preventive action

Perceived Threat of
Disease X

minus

Likelihood of Taking
Recommended
Preventive Health Action

Cues to Action
Mass media campaigns
Advice from others
Reminder postcard from physician/dentist
Illness of family member or friend
Newspaper or magazine article