Consumer access to healthy food is crucial in developing a healthy nation. However, many consumers are unaware of food contents or ingredients and hence may suffer from various food-related diseases. In other words, people might suffer a disease caused by consuming unhealthy food together with an unbalanced diet. Functional foods have been introduced in the market to solve and overcome this consumer health issue. Therefore, the
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HBM can be an effective framework to be used for motivating consumer’s intention towards healthy food, i.e. functional foods, with a special function to prevent diseases. This idea is supported as the HBM have been proven its effectiveness in 46 studies (between 1974 and 1984) related to disease prevention programs. The results establish the significant
effectiveness of the HBM (Becker, 1974).
Rosenstock (1974) elaborates that the HBM is a psychological model. HBM constructs were established as a predictor of preventive health behaviour. The focus of attitudes and beliefs in the HBM endeavours to clarify and anticipate individual’s health behaviour. The model was initially created in the 1950s by a social psychologist. During those days, these psychologists were working at the U.S. Public Health Service to clarify the reason why numerous individuals did not partake in public health programmes, for example, health screening and disease prevention programmes, i.e. TB or cervical cancer screening (Rosenstock, 1974). From that point forward, the HBM has been used to investigate an assortment of health practices. In this manner, it was extended by Rosenstock et al., (1988) to discover varying responses to symptoms and to understand variations in treatment
compliance. It has in this way been utilised to direct interventions to improve compliance with preventive strategies (Janz, 2002). Figure 2.6 demonstrates the fundamental components of the HBM and its constructs.
58 Figure 2-6 The Health Belief Model (HBM)
Source: (Rosenstock, 1974)
Description of determinant and the dependent variable of the HBM model
The HBM incorporates five constructs that affect health action. In the HBM, the probability that an individual will adopt a preventive behaviour or conduct is affected by their subjective weighing of the costs and benefits or advantages of activity, whereby perceptions are represented by the following components:
Perceived Susceptibility alludes to, “one's subjective perception of the risk of contracting a health condition” (Rosenstock, 1974, p. 330). This is a perception of the individual’s belief in their level of vulnerability for a certain condition affecting health. Various health-protective practices have been observed using Perceived Susceptibility. In one example, Perceived Susceptibility may be effective to encourage a consumer to engage in the preparatory practices to avert cancer (healthy behaviour, i.e. get a mammogram or prostate exam, consume low fat diet, quit smoking and do frequent exercise) is subjected upon the degree of vulnerability to the risk of cancer disease of the individual believes that they may
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have (Rosenstock, 1974). Colleen et al., (2000) found Perceived Susceptibility to be an effective predictor of various health-protective behaviour practices.
Perceived Severity/ Seriousness measures convictions about the results of suffering from the condition (Rosenstock, 1974). It investigates emotions concerning the seriousness of getting sick or of abandoning treatment (counting assessments of both medical and clinical results and conceivable social outcomes). For example, an individual will probably take an action to forestall coronary illness if they trust that a conceivable negative physical, mental, and/or social impacts of contracting the disease poses serious consequences (e.g. adjusted social connections, lessened freedom, torment, suffering, disability, or even death).
Perceived Benefits represent the perceived effectiveness of strategies designed to
diminish the danger of disease. This construct measures the benefits of participating in defensive or protective behaviour. Inspiration to act to change conduct requires the conviction that the preparatory conduct successfully prevents the condition. Individual’s “behaviour was thus thought to depend on how beneficial he or she believed the various alternatives would be in his or her case” (Rosenstock, 1974, p. 331). For example, some people might not be persuaded to stop smoking if they believe that such an action is unable to prevent cancer.
Perceived Barriers measures the barriers or losses that avert health behaviour change. In this relation, a person may think that it is essential to uptake certain action to reducing the certain health threat. Nevertheless, the person might see the necessary actions are sometimes painful, expensive, upsetting, inconvenient or unpleasant. This conflicting perception become barriers to action (Rosenstock, 1974). The different level combination of this construct constitutes the expectation of a positive result (i.e. higher level of Perceived Benefits and lower level of Perceived Barriers). Belief alone is insufficient to persuade a person to take action. Prior to taking action, it includes a psychological measure of the net benefits of acting so that action requires that the benefits should exceed the costs.
The costs may incorporate physical impediments, for example, distance, money, time, convenience and physical accessibility (Rosenstock et al., 1988). Besides, Rosenstock et al., (1988) additionally included a psychological barrier to this measurement, including
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individual worthiness of suggested conduct. For an action to occur Perceived Benefits must outweigh Perceived Barriers.
Regardless of the fact that an individual’s Perceived Susceptibility to a health threat is severe, whether the individual will change unsafe practices is affected by the view of the benefits that stem from the changes made. These two constructs (Perceived Benefits and Perceived Barriers) have regularly appeared to be more significant and noteworthy than the others, with Perceived Barriers frequently the critical construct for understanding the execution or not of specific health behaviours (Janz and Becker, 1984; Norman and Brain, 2005; Carpenter, 2010).
Cues to Action include stimuli that motivate a person to take part in preventative behaviour (Rosenstock, 1990). Internal or external stimuli might trigger action. Precisely, the internal Cues to Action include personal physical experiences such as pain or the onset of illness. External Cues to Action such as a doctor's guidance, a life partner's ailment or the demise of a guardian or companion may likewise trigger a change in health behaviour.
The dependent variable for original HBM is Taking Recommended Preventive Health Action” (Rosenstock, 1974, p. 334). Rosenstock (1974) explains it as the individual’s
behaviour towards engaging in healthy behaviour (i.e. acceptance or rejection on preventative health services). This outcome is used to comprehend the individual’s inspirations and
motivations in engaging certain behaviour.
According to the HBM model, Rosenstock (1990) explained that the probability that someone will take action to avert disease relies on the perception of whether they are vulnerable to a certain condition that could be severe and that there is a preventative action to avoid the condition, and that the perceived advantages of decreasing the threat of the condition exceeds the costs of action. These constructs impact on the likelihood of
performing protective health behaviour and practices by affecting the perceived threat of the disease and assumptions about the result. In relation to this, an individual would take the action if the readiness to act is strong towards the importance of the recommended preventive health behaviour.
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The original HBM study was established to integrate a stimulus-response theory with a cognitive theory in clarifying behaviour conduct. The logic of the HBM derived from Lewin's (1939) theories which emphasise that perception of reality, instead of target reality, impacted on behavioural conduct. Previously, the stimulus-response theory focused on the significance of the outcomes of conduct in anticipating actions, while the cognitive theory changed this by focusing on the importance of the individual's subjective valuations, and their judgment of the probability of required or the desired results would be obtained in the action. The methodology integration of the stimulus-response theory with the cognitive theory has created a value-expectancy theory. Furthermore, the value-expectancy theory emphasises that incentive would not directly stimulate an individual to undertake specific actions; rather it would affect a person’s assessment of the action and its probability of the results (Janz, 2002). From this perspective, health behaviour practices are determined by a person's intention to avoid risk and, and the certainty that the prescribed action would accomplish it (Janz, 2002). This inferred a phenomenological method that implies it is not the “real” world, but rather the individual's view and a perception of it that impacts their behaviour conduct. It was an early endeavour to enhance a behaviourist, explored by a response model and to integrate cognitive components.
Several studies provide evidences of the effectiveness of the constructs to predict behaviour (Janz and Becker, 1984; Mullen et al., 1987). Attention should be given to statistical aspects when using the HBM as the theoretical basis for data collection. In
particular, Strecher and Rosenstock, (1997) described that one of the essential components in the HBM is known as Perceived Threat which is a combination of the two constructs of Perceived Susceptibility and Perceived Severity. It is important to note and understand that Perceived Threat is not a construct per se in the HBM. Nevertheless, only simple effects of Perceived Susceptibility and Severity establish on model revisions, particularly on the impact of perception of risk (Brewer, et al., 2007). In addition, there are also some issues with other constructs in the HBM. In particular, the limitation of subtracting the rating between the constructs of Perceived Barriers and Perceived Benefits (Mullen et al., 1987). This issue might be reduced if the analysis focuses on separating the roles of each constructs towards health behaviour.
Rosenstock (1974) added a fifth HBM construct, which is Cues to Action. This additional construct does not rely on expectancy or the value rather it captures another
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influence. Cues to Action could be from medical symptoms, a doctor’s recommendation, or alert from a media campaign. The magnitude of the cues required to trigger action depends on the motivation to change and the perceived net benefit of action (Rosenstock, 1974).
This construct has proven significant to influence behavioural changes in many applications of the model. For example, Morowatisharifabad et al., (2014) found Cues to Action (i.e. accurate information from healthcare providers, and veterinary professionals) significantly effective to influence individual behaviour to uptake the rabies preventive measures. The role of Cues to Action in relation to food and healthy behaviour involves social influences (Feunekes et al., 1998). The social support and influences on a healthy diet, such as suggestions from friends and family may escalate an individual’s interest and
intention to consume healthy foods (Devine et al., 2003). In other previous study, there was evidence that social influences of family and friends have a positive impact towards dietary changes to consume more fruits and vegetables (Cohen et al., 1998). Positive Cue to Action also indicates that an individual is having a feeling of a group belonging in social support and trusting them, thus would encourage healthy behaviour (Berkman, 1995). Anderson et al., (1998) explain that the family is broadly recognised as a significant influence on food
choices, hence supporting dietary improvement. Receiving dietary advice which is proper and adequate may benefit the individual and would affect the dietary patterns of others. In a more recent study, Rezai et al., (2017) found that Cues to Action (family members, friends and doctor) are significantly influenced individual attitude and attention to the consumption of synthetic functional foods.
Rosenstock et al., (1988) further extended the HBM, adding a sixth construct, Self- Efficacy. It can be defined as an individual’s confidence in the ability to perform certain actions (Rosenstock et al. 1988). Uniquely, this construct does not rely upon expectancy and value; nevertheless, it fits into the framework of expectancy and value. Precisely, the role of Self-Efficacy in the HBM is known as to reflect the outcome of repetitive behaviour i.e. eating, smoking, and physical activity to influence behaviour. In the study of health behaviour which is relatively easy to perform, this construct of Self-Efficacy may not be essential.
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