Integrating these different health beliefs: developing models
In summary, attribution theory and the health locus of control emphasize attributions
for causality and control, unrealistic optimism focuses on perceptions of susceptibility
and risk and the stages of change model emphasizes the dynamic nature of beliefs,
time and costs and benefits. These different aspects of health beliefs have been integrated
into structured models of health beliefs and behaviour. For simplicity, these models
are often all called social cognition models as they regard cognitions as being shared by
individuals within the same society. However, for the purpose of this chapter these
models will be divided into cognition models and social cognition models in order to
illustrate the varying extent to which the models specifically place cognitions within a
social context.COGNITION MODELS
Cognition models examine the predictors and precursors to health behaviours. They are
derived from subjective expected utility (SEU) theory (Edwards 1954), which suggested
that behaviours result from a rational weighing up of the potential costs and benefits
of that behaviour. Cognition models describe behaviour as a result of rational informa-
tion processing and emphasize individual cognitions, not the social context of those
cognitions. This section examines the health belief model and the protection motivation
theory.The health belief model
The health belief model (HBM; see Figure 2.3) was developed initially by Rosenstock
(1966) and further by Becker and colleagues throughout the 1970s and 1980s in order
to predict preventive health behaviours and also the behavioural response to treatment
in acutely and chronically ill patients. However, over recent years, the health belief model
has been used to predict a wide variety of health-related behaviours.Components of the HBM
The HBM predicts that behaviour is a result of a set of core beliefs, which have been
redefined over the years. The original core beliefs are the individual’s perception of: susceptibility to illness (e.g. ‘my chances of getting lung cancer are high’);
the severity of the illness (e.g. ‘lung cancer is a serious illness’);
the costs involved in carrying out the behaviour (e.g. ‘stopping smoking will make me
irritable’);
the benefits involved in carrying out the behaviour (e.g. ‘stopping smoking will save
me money’);
cues to action, which may be internal (e.g. the symptom of breathlessness), or
external (e.g. information in the form of health education leaflets).24 HEALTH PSYCHOLOGY