Monday, April 8, 2013

Theories and Theorists

Models and theories are foundational in the development of any discipline. This paper will explicate the theorists, sources, and basic tenets of the Health Belief Model (HBM) and Engel's (1977) Biopsychosocial Model (BM) of health and illness, assess the relationship between the two models, and explain their importance to health psychology and medical science. Further, it will evaluate the role of these models in my intended research.

                                              Key Theories in Health Psychology

The BM and the HBM are fundamental models that examine the complex association between physical and psychological health, and how individuals are motivated to change. The former was a seminal discussion on the need for a transition from a solely medical model of health to one that incorporated the effects of thought processes on health and illness (Engel, 1977). The latter, a model of behavior change, focuses on the likelihood that an individual will change. Both models guide understanding in health psychology and provide parameters for research in this field as well as in many other disciplines (Redding, Rossi, Rossi, Velicer & Prochaska, 2000).

                                              Theorists, Sources, and Basic Tenets

The Biopsychosocial Model of Health

         Theorist and Source. The classic work of George Engel (1977) contended that the linear concept of the medical model of health was in crisis because of an antiquated system that was "no longer adequate for the scientific tasks and social responsibilities of either medicine or psychiatry" (p. 317). He further postulated that defining disease within strictly biological parameters did not adequately serve those who relied on the medical profession. Engel (1977) believed medical science needed a model that fairly and accurately accounted for the personal human experiences of disease (Engel, 1977). In a later classic work, Engel (1980) developed the concept of the model's usability in clinical applications.

         Basic Tenets. The Biopsychosocial Model of Health was first suggested as a way to evolve from the linear science of medicine to a holistic perspective that includes multiple contributing factors to illness, including biological, psychological, and social influences (Engel, 1977; 1980). Further, this model introduced people to the new idea that they could perceive themselves as participants rather than as victims of disease (Marks, Murry, Evans, & Estacio, 2011). The model changed individual accountability for healthy behaviors, and it demanded a new, comprehensive design for healthcare.

The Health Belief Model
         Theorist and Source. The Health Belief Model (HBM) was first introduced in the 1950s by employees of the Public Health Service to predict which individuals would utilize public programs designed to prevent and diagnose disease, as well as to determine why many individuals failed to use those resources (Rosenstock, 1960). Rosenstock's (1960) seminal research into this topic inspired ongoing research into health behavior. Rosenstock and others sought to understand why individuals did or did not take advantage of tuberculosis screening (Glanz et al., 2008). Later, classic articles by Becker (1974) and Kirscht (1974) described how the HBM could be utilized to study how people responded to diagnoses of disease and their symptoms, and how they complied with medical recommendations for treatment.

         Basic Tenets. The HBM focuses on the likelihood that individuals will be motivated to act to prevent an illness according to how they perceive their personal vulnerability, the seriousness of the disease, the benefits and costs of taking action, and their sense of self-efficacy to effectively change their behavior (Glanz et al., 2008; Redding et al., 2000). These four factors influence the chance that an individual will act in a way that will mitigate the perceived threat and seriousness of the illness. This model of behavior change is a behavior expectancy theory that assumes individuals value the avoidance of illness and they expect that certain behaviors will help them avoid it (Glanz et al., 2008).

                                           The Relationship Between the Theories

The HBM and the BM both stem from the understanding that the psychological and sociological aspects of individuals play a significant role in health. Because the HBM implicates individuals in the process of health and illness, the BM aimed to fill the gap in medical science and move toward a holistic system of health care, rather than the well-established linear model. Both models stem from an increase in understanding the social and psychological aspects of human health, and the role of the individual as a contributor in health and illness. The models perceive the individual as participatory, that they can affect their health outcomes. The BM was perhaps borne from a need created by the increased understanding that individuals do, in fact, have the power to change their health outcomes through behavior. This understanding became a provocation to medical science, that it must broaden its perception of the role of the individual in health care. The BM sought to fill a gap in medical science, a gap that had been widened by the conceptualization of individuals' role in health and illness.

                                                  Importance of the Theories

The Biopsychosocial Model

Engel's (1977) BM and the HBM are fundamental in the field of health psychology. In essence, health psychology was borne from Engel's general contention about illness and healing, and that medicine must evolve into a science that embraced the biological, psychological, and social aspects of disease (Redding et al., 2000). Engel's (1977) model continues to be utilized in a variety of other fields including social work, family therapies, mental health counseling, and clinical psychology. Various models of changing health behavior are aligned with Engel's original idea, that biological, psychological, and social factors contribute to health as well as illness. Further, modern medicine continues to evolve from a reductionist biomedical model to one that embraces the human aspects of illness and disease. Although McLaren (2002) trenchantly claims Engel's model was only a plea, not a fully designed or defined model or theory, it continues to influence the health fields as a seminal work upon which other models and theories on illness and disease are based.

My intended research stems, albeit indirectly, from Engel's idea that biological medicine must evolve, and to effectively heal disease and promote health, it is essential to grasp all of its contributing factors. My research is partly based on the theory that psychological support, in time of challenge, crisis, or illness, palliates some level of pain and suffering, and perhaps supports and even promotes biological healing. The Social Cognitive Theory partly informs this concept, although Engel's BM directly inspired investigation into other modes of healing. Social support has been empirically found to be integral in healing, along with pharmacological treatment and surgical interventions.

The Health Belief Model

Understanding an individual's role in health behavior is an essential component in health psychology. This understanding informs successful interventions, public health programs, and research in many fields (Glanz et al., 2008). Further, the HBM has inspired thousands of studies on health education and health behavior and is foundational in many effective interventions (Glanz et al., 2008). Equally important, the HBM has contributed to understanding how and why people change health behaviors and further, this model has been utilized to change health behaviors, which is an important element in people's lives. Considering that the twelve leading causes of death are preventable by a change in health behavior (Marks et al., 2009), this model of understanding how to facilitate this change becomes even more significant.

The HBM is important to my research, although the relationship may be considered indirect. The participants in my research have already been diagnosed with a disease, and are implementing resources practical to their situation, with the hope of facilitating the most positive outcome. They cannot avoid the disease, but they can work toward gaining self-efficacy. According to the HBM, an individual perceives self-efficacy when they are convinced that they can and will act successfully in a way that will produce the most favorable outcome for themselves (Bandura, 1997). The HBM implies that individuals have the capacity to make the ultimate contribution to positive health outcomes in the form of behavior change. With adequate information, this may include seeking psychological support as one component of behavioral change that may facilitate a positive outcome. My research interests are in creating a more accurate understanding of the role of online support and its effects on health and well-being.


The HBM and the BM are integral in the field of health psychology. Health behavior and its changeable nature is perhaps humankind's hope for preventing diseases that are, in fact, preventable. The BM embraces models and theories that contribute to the changing role of the individual in health care and the prevention of illness, and continues to hold medical science accountable to including the full range of contributing factors to health and illness. As an aspiring health psychologist, these models will guide my research as well as provide a parameter by which to explore the dimensional characteristics of human health and well-being.


Bandura, A. (1997). Insights. Self-efficacy. Harvard Mental Health Letter, 13(9), 4-6.

Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2, 324-473.

Engel, G. (1977/2012). The need for a new medical model: a challenge for biomedicine. Psychodynamic Psychiatry, 40(3), 377-396. doi:10.1126/science.847460

Engel G. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535–44.

Kirscht, J. P. (1974). The health belief model and illness behavior. Health Education Monographs, 2, 2387-2408.

McLaren N (2002). The myth of the biopsychosocial model. The Australian and New Zealand Journal of Psychiatry, 36(5): 701–703.

Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health psychology: Theory, research, and practice (3rd ed.). Los Angeles, CA: SAGE.

Redding, C. A., Rossi, J. S., Rossi, S. R., Velicer, W. F., & Prochaska, J. O. (2000). The International Electronic Journal of Health Education, 3, 180-193.

Rosenstock, I., M. (1990) The health belief model: explaining health behavior through expectancies. In: Glanz, K., Lewis, F. M., Rimer, B. K., eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass; 39-62.

Rosenstock, I. M. (1960). What research suggests about public health. American Journal of Public Health, 50, 295-302.

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