Theories of health belief

Health belief model - Becker

Locus of control - Rotter

Self- efficacy - Bandura

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Becker; Compliance with a medical regimen for asth

Aim: To use the Health Belief Model (HBM) to test mother's compliance to the medical regime for their children with asthma. 

Background: Kurt Lewin's HBM has a phenomenological orientation, i.e. it is the patient who decides what he will or will not do and no the physical environment or the medical advice he/she receives. This depends on: 1)How likely the patient believes he/she will get a condition (perceived susceptibility); 2)The fear of the disease (perceived seriousness); 3)The patients beliefs about the availability and effectiveness of treatment (perceived benefits); 4)A cue to action which could be internal ( a change in a person's bodily state) or external (publicity about a disease); 5)Their age, sex, race, ethnicity, social class, peer groups and knowledge about the disease. 

Sample: 111 mothers of children aged 9 months to 17 years.

Procedure: A correlational design was used with interview question designed to provide measures of the HBM and how mothers had handled the latest asthma attack ('soft' measure). In addition, a covert blood test was taken to see if the asthma drug was in the childs system ('hard' measure).

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Becker; Compliance with a medical regimen for asth

Results: 80 childrens blood tests showed a 66.3% compliance rate. Becker and Rosenstock conclude that with both measures, mothers acted in ways predicted by the model. Mothers who feared that their child was vulnerable to a serious condition and that the asthma interfered with a child's activities were the more likely to comply. Reliability is high because it is consistently backed up by research which shows similar results each time. It supports a dispositional explanation of behaviour rather than a situational one becaue it is based on an individual's perception of their own state.

Evaluation: This behaviour seems more indicative of free will in action than a determinist viewpoint because the mothers seemed to be making choices about whether or not to medicate their children, although one could argue that it was the seriousness of the condition that had most effect. The usefulness is high because the model can be applied to many health problems; professionals who apply it will get greater compliance to medical advice.

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Rotter; Generalised expectancies for internal vs.

Aim: To test whether a reward is more effective if a person believes it came as a result of their own efforts (internal locus) or as a reuslt of fate or chance (external locus).

Background: Rotter's theory suggests that  if a person believes that reinforcement for behaviour is the result of their own efforts in either a positive or a negative way, it will strengthen their behaviour so they try harder to give up  more quickly ina future similar situation. If he sees the behaviour as chance, it's less likley to be repeated. Applied to health, it could explain why some people repeatedly fail to lose weight by giving up on various diets when weight loss progress is slow. Similarly the fast results gained from using an inhaler for asthma is likely to lead to regular use and the belief that using medication works.

Sample: 6 pieces of researchin a review article.

Methods: Lab experiments using tasks such as line matching with very tiny differences, steady hand and extra sensory perception tasks, In one condition the participant thinks he is in control (skill-based); in the second condition there are both chance - and skill- based tasks. In both conditions participants are reinforced as right ot wrong; however, success or failure is controlled by the experimenter.

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Rotter; Generalised expectancies for internal vs.

Results: Behaviour changes are significantly greater when the participant believes their own skill causes their success or failure in a task. It also takes far longer for them to give up (extinguish behaviour).

Evaluation: There is much construct reliability as each of the six experiments supports the others and the original theory. Control is high with the lab experiment design so the IV and DV are clearly isolated and can determine a causal relationship. However, ecological validity is low with these artificial tasks. None if the 6 experiments have any health- related tasks or ill participants so generalising the results to health behaviour lacks mundane realism. This is a determinist theory suggesting human behaviour can be manipulated by reinforcement - behaviourist assumption. Supports nurture over nature. Shows an interaction between situational and dispositional factors. When applied to health behaviour, it explains why some people carry on smoking when they know it will increase their risks of dying early. They may have an external locus of control and be trusting to luck.

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Bandura and Adams; analysis of self-efficacy theor

Aim: To apply systematic desensitisation techniques to change a patient's self -efficacy so they come to believe they can cope with a threat.

Background: Bandura's theory of self- efficacy states that if a person believes that they can cope with a threat, they will use more effort and try for longer in the face of obstacles and unpleasant experiences. If they then master their fear, their self-efficacy further increases.

Sample: 9 females and 1 male snake phobics aged 19-57 with a mean age of 31 were recruited by advertisement.

Method: A quasi-experiment. A series of pre- tests were given to the snake phobics to test their level of fear using rating scales of 1- 10 for how frightened they would be to approach a boa constrictor in a case, to look down at it, touch it with gloves or bare hands, let it loose and catch it and hold it within 12cm of their faces. Self-efficacy was tested by using a 100-point probability scale for how likely they felt they would succeed in the task above before they entered the room with the snake. 10 points on the scale was virtually impossible. they then received systematic desensitisation training including deep relaxation and visualisation of 51 genes over about 4.5 hours.

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Bandura and Adams; analysis of self-efficacy theor

Results: In the post test, the boa constrictor was used to test changes in seld - efficacy and a corn snake used to see if self-efficacy generalised to other snakes. Bandura found that desensitisation reduced anxiety towards both threats and increased self-efficacy.

Evaluation: Lab experiment so high control and ability to test the effect of the IV (desensitisation), on the DV (fear and self-efficacy). Supports an interactionist position in the nature/nurture debate. A person's self efficacy is affected by personality and environment. It shows an interaction between free will and determinism. The theory can be widely applied to anxiety disorders.

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