This post is a continuation on our discussion about psychosocial aspects related to health behavior changes. Again, by equipping ourselves with a general understanding of components that play into motivation, change, and adherence, we can better address our patients’ individual needs. We began with introducing the Transtheoretical Model and will continue with the Health Belief Model.
The Health Belief Model (HBM) is a psychological model that attempts to predict health behaviors. Major concepts that indicate people are likely to comply with an HEP include: perceived susceptibility, perceived severity, perceived threat, perceived benefits, perceived barriers, cues to action, and self-efficacy. Below are definitions of each of these concepts:
Perceived susceptibility: a person’s belief about their likelihood of getting a disease or condition. For example, during one of my earlier clinical experiences, I recall a patient who was very engaged in her rehab plan. She had experienced multiple ankle sprains before, but wanted to avoid surgery at all costs. Her belief (and the fact) that a history of ankle sprains is an indicator for recurrent sprains motivated her in and outside of the clinic. PTs can use this concept by educating patients on the risk of noncompliance and the likelihood of a further decline in health or function if attention isn’t given to their deficits.
Perceived severity: the belief about the seriousness of contracting a condition and/or leaving it untreated. In the example described above, the patient admitted poor compliance after her first ankle sprain because she chalked it up as a ‘freak accident’ and that it would heal on its own. After experiencing her third lateral ankle sprain and her doctor discussing a potential need for surgery, the patient realized the severity of her injury, particularly as it became more painful to ambulate and affected her participation in her activities.
Perceived threat: formed by the combination of susceptibility and severity; thus, if there is no perceived susceptibility or severity, then the perceived threat would be zero.
Perceived benefits: the belief in the benefits of continuing a healthy behavior to reduce threat. In the same patient case above, she was able to tolerate manual therapy to mobilize the scar tissue in her ankle because she understood its benefits in helping her regain full dorsiflexion. Though uncomfortable, the patient was educated on the need for reorienting the scar tissue fibers to prevent adhesion.
Perceived barriers: the possible obstacles to taking action, including negative consequences resulting from an action. All of our patients have different personal factors that can interfere with their plan of care. It’s important to listen to our patients’ individual circumstances to better identify, understand, and address these barriers.
Cues to action: internal or external factors that instigate action. These vary by the individual and are required to make perceived threat or perceived benefits relevant.
Self-efficacy: belief that one can perform the recommended health behavior. PTs can improve this in patients by providing training and guidance in the recommended action, using reasonable and progressive goal setting, and giving reinforcement to support patient confidence.
Ultimately, by keeping these concepts in mind, PTs can gear their educational ‘talk’ with patients on the risks and benefits of physical therapy. Anecdotally, I have had success in my clinical experiences by explaining to patients that if they commit to their HEP, our visits can be much more effective, which leads to a faster recovery and return to their desired activity level.
In addition to education on the patient’s condition and risks/advantages of compliance or noncompliance with a HEP, a PT can recruit social support to empower patients. Encouraging the patient to engage their family/friends in their rehabilitative process, stress may be alleviated. Not only does social support attenuate the burden of a present condition, protective aspects of social support have also been shown, such as in mitigating the risk for coronary heart disease and mortality. Having social support can also elicit positive outcomes in patients with chronic conditions, such as cystic fibrosis.
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5. Pop-Jordanova N, Demerdzieva A. Emotional health in children and adolescents with cystic fibrosis. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2016; 37(1): 65-74.doi: 10.1515/prilozi-2016-0005