Development of the health belief model (HBM)
In the 1950s US public health researchers began developing psychological models designed to enhance the effectiveness of health education programmes (Hochbaum, 1958). Demographic factors such as socio-economic status, gender, ethnicity and age were known to be associated with preventive health behaviours and use of health services (Rosenstock, 1974), but these factors could not be modified through health education. Thus the challenge was to develop effective health education targeting modifiable, individual characteristics that predicted preventive health behaviour and service usage.
Beliefs provided an ideal target because they are enduring individual characteristics which influence behaviour and are potentially modifiable. Beliefs may also reflect different socialization histories arising from demographic differences while, at the same time, differentiating between individuals from the same background. If persuasive methods could be used to change beliefs associated with health behaviours and such interventions resulted in health behaviour change then this would provide a theory-based technology of health education.
An expectancy–value model was developed in which events believed to be more or less likely were seen to be positively or negatively evaluated by the individual. In particular, the likelihood of experiencing a health problem, the severity of the consequences of that problem, the perceived benefits of any particular health behaviour and its potential costs were seen as core beliefs guiding health behaviour (see ‘Expectations and health’).
Rosenstock (1974) attributed the first health belief model (HBM) research to Hochbaum's (1958) studies of the uptake of tuberculosis X-ray screening.