Wednesday, March 20, 2013
The Health Belief Model and the Transtheoretical Model: Similarities and Differences Similarities
Both models aim to determine what it takes for people to protect themselves from illness (Clemow, 2004) and to understand, predict, and affect individual's health behaviors and the ability to change (Glanz, Rimer, Viswanath, 2008). The Health Belief Model (HBM) is a cognitively based model that focuses on mental processes as they pertain to changes in health behaviors. It does not concern itself with the emotional component of health behaviors. The Transtheoretical Model, however, is concerned with the behavioral aspect of health behavior change, specifically the attitudinal stages of awareness or readiness of the individual (Glanz et al., 2008; Rossi, 2004). Both models focus on awareness, although the HBM focuses on constructs that promote change and TTM focuses on attitude and belief stages that are antecedent in the ability to change. Both models take self-efficacy into account.
Whereas the HBM focuses on perceived risks and self-efficacy, the TTM concerns itself with readiness to perceive. Interventions based on HBM and TTM both focus on creating awareness, although HBM is cognitively based, and TTM is behavior-oriented (Clemow, 2004; Glanz et al., 2008; Rossi, 2004).
Whereas TTM uses stages and experiences of individuals placed into discrete categories, the HBM uses value-based constructs that are not discrete but are easily perceived on a continuum (Berg, 2004). The HBM focuses on generally applied interventions whereas the TTM is concerned with individually tailored interventions (Berg, 2004). The TTM, however, must take into account the individual's stage prior to educating them. The TTM is based on individual readiness and the HBM is concerned with individual attitudes and beliefs (Glanz et al., 2008). Brug (2004) believed that HBM is evidence-based whereas TTM is social or culturally-based.
TTM assumes interventions should be prescribed according to individual readiness, whereas HBM claims generally prescribed interventions will affect most individuals. HBM argues that behavior reflects perceived values whereas TTM claims that behavior reflects readiness to respond (Glanz et al., 2008).
Examples of Models in Practice
For example, the HBM theorizes that individuals will be prompted to take action according to value placed on illness, susceptibility, and their ability to avoid the illness. For example, in the case of women's cancer screening, a woman must perceive the actual threat of breast cancer, that the cancer can be avoided by breast cancer screening, and that she is capable of accessing the resource of screening at her local clinic, which may include remembering the appointment, having the financial resources to pay for the screening, driving herself to the clinic, and not being afraid of the procedure (Aşcı, & Şahin, 2011).
The TTM may be better utilized in a population that has limited to no understanding of a particular disease and its prevalence in the population. Using the same example, women in some populations may not be aware of the risk of breast cancer (the precontemplation stage), so women did not consider preventive screenings. In the second stage of contemplation, women have become aware that there is a risk they may have breast cancer at some point in their lives and began to think about being screened at their local clinic. In the Preparation stage, women are ready to take action because they understand the importance of making changes to their behavior. They may discuss their choice to change with close friends and family. During the maintenance stage, women are well aware of their susceptibility to breast cancer, but must be reminded to maintain their regular screening routine (Glanz et al., 2008).
Although many scientists believe there is a paucity of research on the use of TTM, others believe it is effective for changing some health behaviors (Velicer, Redding, Sun, & Prochaska, 2007) Other research, however, suggested TTM-based interventions were no more effective than HBM-based interventions (Riemsma et al., 2003). Eisen (1992) suggested gender differences and other variables may make one model more effective than the other in different circumstances.
Aşcı, Ö., & Şahin, N. (2011). Effect of the Breast Health Program Based on Health Belief Model on Breast Health Perception and Screening Behaviors. Breast Journal, 17(6), 680-682. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1111/j.1524-4741.2011.01143.x
Brug, J. (2004). The Transtheoretical Model and stages of change: A critique: Observations by five Commentators on the paper by Adams, J. and White, M. (2004) Why don't stage-based activity promotion interventions work? Health Education Research, 20(2), 244-258. doi: 10.1093/her/cyh005
Clemow, L. (2004). Health belief model. In N. Anderson (Ed.), Encyclopedia of health and behavior. (pp. 390-393). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412952576.n113
Eisen, M et.al. (1992). A Health Belief Model — Social Learning Theory Approach to Adolescents' Fertility Control: Findings from a Controlled Field Trial. Health Education Quarterly. Vol. 19.
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass.
Velicer, W. F., Redding, C. A., Sun, X., & Prochaska, J. O. (2007). Demographic variables, smoking variables, and outcome across five studies. Health Psychology, 26, 278-287.
Riemsma, R. P., Pattenden, J., Bridle, C., Sowden, A.J., Mather, L., Watt, I. S., Walker, A. (2003). Systematic review of the effectiveness of stage based interventions to promote smoking cessation. British Medical Journal 326(7400), 1175–1177. doi: 10.1136/bmj.326.7400.1175
Rossi, J. (2004). Transtheoretical model of behavior change. In N. Anderson (Ed.), Encyclopedia of health and behavior. (pp. 719-722). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412952576.n211