NURS 8123 Assignment 7.1 Theoretical Framework/ Conceptual Models and Middle-Range Theories Paper

Student Name

State University

NURS 8123

Professor

July, 2023

Integrating the Health Belief Model and the Theory of Planned Behavior to Enhance Health Promotion in Nursing Practice

Conceptual models and theoretical frameworks are crucial in nursing to offer a systematic way of describing, analyzing, and anticipating occurrences in the discipline. These frameworks and models provide the structure for the nursing practice, education, and research to organize knowledge and necessary interventions properly (Foroughi et al., 2022). The current study discusses the relevance of the chosen theoretical framework, the Health Belief Model (HBM). The HBM is effectively used to analyze health behaviors by considering factors such as beliefs about health conditions, expected advantages of action, and constraints. This study will provide an overview of the Theory of Planned Behavior (TPB), the middle-range theory associated with the HBM (Huang et al., 2020). The TPB builds on the HBM by adding perceived behavioral control and it is essential for understanding health behaviors. By reviewing these frameworks, we will demonstrate their applicability in the nursing field, especially in developing successful health promotion strategies. This paper aims to emphasize the value of integrating the theoretical and practical for enhancing better patient care and the development of the nursing discipline.

Theoretical Framework: Health Belief Model (HBM)

Description of Framework/Model

The Health Belief Model (HBM) is a psychological model formulated in the mid-1950s by Hochbaum, Rosenstock, and Kegels, who worked with the U.S. Free Health Service. The HBM was initially developed to account for the lack of people in disease prevention and early detection programs (Huang et al., 2020). It has expanded over the years to encompass more than what was initially defined and is currently one of the best-known models to describe health-related behavior. According to the HBM, people’s beliefs on the conditions of specific health states, the benefits of performing a particular behavior, and the risks associated with this change affect the behavior. It underlines self-interpreted meanings and changes in behavior to make them applicable in developing public health initiatives and educational activities. 

Concepts and Propositions

The HBM consists of several key concepts and propositions that provide a comprehensive understanding of health behavior.

• Perceived susceptibility is the extent to which a person believes they are at risk of contracting a disease or illness. It was established that the higher the perceived susceptibility, the more an individual is likely to practice to minimize the risk (Akther & Nur, 2022).
• The perceived severity relates to an individual’s perception of the threat posed by a particular disease, condition, and its consequences. If a person thinks that the condition has fatal consequences, then this person will be able to take preventive measures.
• In the perceived benefits concept, uncovering relates to the individual’s perception of the effectiveness of the advised action to lower the risk or seriousness. In other words, the perceived benefits enhance the likelihood of the specified behavior occurring.
• Perceived barriers are obstacles that hinder the undertaking of an activity. They can be physical, such as cost or time, or psychosocial, such as fear or humiliation. The fewer the barriers perceived, the higher the possibility of performing the recommended action by the individual (Akther & Nur, 2022).
• The cue-to-action notion is related to external stimuli that require specific actions from people. Potential cues may be through media or from other people, such as reminder calls from a healthcare provider. 
• Self-efficacy was incorporated into the HBM and added later. Self-efficacy is defined as the level of confidence that the individual has in acting on the behavior. On the other hand, higher self-efficacy can potentially raise the probability of behavior change significantly (Moey et al., 2021).

Propositions

The HBM maintains that the perceived diagnosis and treatment of a disease influence health behavior. This suggests that perceived susceptibility, perceived severity, perceived benefits, and perceived barriers influence the likelihood of engaging in health behavior.

Additionally, the model suggests that health-promoting behavior depends on cues to action that activate decision-making and self-efficacy in performing the behavior. Analyzing the HBM in detail shows that enhanced knowledge of this theory will allow healthcare professionals to create better health interventions. These interventions can be individualized to provide input to the perceived and actual incentives of the patients and the community for increasing the possibility of behavior change and better health. The HBM declares that healthcare behavior results from beliefs and perceptions of this theory, which is instrumental in health education and behavior change for developing healthier promotion approaches.

Middle-Range Theory: Theory of Planned Behavior (TPB)

Description of Theory

The Theory of Planned Behavior (TPB) is one of Ajzen’s middle-range theories, formulated in the late 1980s, based on the health belief model. The theory of planned behavior has been designed to explain the motivational factors that affect behavior by relying on intention, the most critical factor (Park & Shin, 2021). Covering attitudes and subjective norms also includes the notion of perceived behavioral control, which offers an enhanced method of analyzing people’s decisions about health behaviors. The TPB suggests that individual behavior is driven and influenced by three key factors: stereotypical perceptions of the behavior, perceived norms, and control over the behavior. It has been applied widely to predict health behavior change and constitutes a valuable model for developing health interventions.

Processes or Concepts

This attitude toward the behavior concept measures the extent to which the individual has positive or negative perceptions towards the undertaking of the behavior. The specificity of attitudes is determined by assumptions concerning the consequences of the behavior and the stakes given to them. In perception, the chances of performing a given health behavior are likely to be high if the person holding the perception feels it will have a positive outcome (Gjicali & Lipnevich, 2021). The subjective norms include the assessment of the society’s expectations towards the implementation or non-implementation of the particular activity. This concept derives from the judgment that individuals have regarding the perceived expectations of their family, friends, peers, or society regarding their behavior. If others who matter in the individual’s social life encourage the behavior, the individual will have a positive attitude toward performing the behavior.

Further, perceived behavioral control can be defined as the extent of the individual’s perception of the likelihood of performing the behavior. This concept is close to the self-efficacy of the HBM and refers to the perceived ease or difficulty of the behavior, considering prior experiences and expected difficulties (Ataei et al., 2020). Enhancing perceived behavioral control enhances the formation of a solid intention to perform the behavior. Behavioral intention is the core of the TPB model and depends on attitudes, perceived norms, and perceived control. Intention refers to the willingness of a person to engage in a particular behavior and is closer to behavior than attitude. The stronger the intention to perform a specific behavior, the higher the probability that the behavior will be exhibited. 

Clinical Practice Application

The theory of planned behavior is helpful for understanding and predicting health-related behaviors in clinical settings. Minimizing the gap can be achieved by reducing the discrepancies between intention attitudes, perceived subjective norms, perceived behavioral control of healthcare providers, and effective interventions to work on these areas (Sultan et al., 2020). They can also be used to promote health promotion, create awareness, change attitudes, enhance supportive social norms, and increase perceived behavioral control. For example, in promoting smoking cessation, interventions can be targeted to facilitate the adoption of the health benefits of quitting (attitudes) and support from family peers (subjective norms). Increase the confidence to quit smoking by providing resources and training (perceived self-efficacy).

Behavioral clinicians decide to attend to patients’ attitudes about healthy behaviors in consultation, understand the pressure from social factors, and uncover reasons why patients feel helpless regarding certain health behaviors (Traina & Feiring, 2020). This approach provides specific individual counseling for each patient and differs in the motivational aspects of practice. The TPB can help design and assess health programs as it points to constructive factors of behavior change.

 For example, in the context of a program promoting physical activity among patients with chronic diseases, the TPB can be helpful regarding the benefits of exercise, pressures, social support, and resistance to exercising regularly. Assessing the changes in these factors may help to understand the efficacy of the program and some of the issues that exist to address(Traina & Feiring, 2020). By identifying the key determinants of health behaviors, the TPB provides the basis for assessing health outcomes and improving clinical management. For instance, the extent of compliance with medication may be improved by attitudes, social support, and perceived control in patients with chronic illnesses.

Analysis of Middle-Range Theory and Conceptual Model

Characteristics of Conceptual Model

The HBM and TPB are helpful in understanding health behavior, but both theories provide it slightly differently. The HBM simply pays attention to the perceived characteristics of the people regarding a specific health state. While the TPB underlines the concept of intention and perceived behavioral control (Qiao et al., 2021). Some aspects of the HBM can be identified within the TPB demonstrates that both frameworks are related and interdependent.

Firstly, the HBM, perceived susceptibility, and severity are core to knowing why the individual is encouraged to undertake certain health behaviors. The TPB also uses these ideas in its construct of attitudes. Susceptibility and severity are best encompassed in the definition of attitudes in that they are an individual’s belief about the consequences of a behavior. For instance, a person’s perception of exercising may be affected by their perceived probability (susceptibility) and magnitude (severity) of contracting cardiovascular diseases (Qiao et al., 2021). Secondly, the perceived benefits and barriers to action in HBM correspond in some way to the attitudes toward behavior and perceived control in the TPB. The perceived benefits can be observed in the attitudes belonging to TPB, and barriers to action are covered by perceived behavioral control (Park & Shin, 2021). This theory founded its position on the concept that perceived expectations are the primary determinant of intending to perform healthy behavior habitually, and self-effort beliefs govern the Type A behavior pattern.

Thirdly, the TPB does not address the concept of cues to action despite suggesting the impact of external pressures through subjective norms. These norms refer to the social influences and expectations from significant others regarding certain behaviors (Park & Shin, 2021). For example, a doctor’s recommendation or a relative’s encouragement may act as triggers to action that ensure changes to a healthier lifestyle occur. Fourthly, integrating self-efficacy into the HBM model correlates most with the TPB’s perceived control over the behavior. Both constructs focus on the individual’s perceived self-efficacy in engaging in a behavior. This similarity has obsessed confidence and control in stimulating motivational health behaviors.

Comparison and Contrast

Both the HBM and TPB are similar in that they are both theoretical models; they have specific differences that affect their relevance and usefulness in clinical contexts. First, it is essential to note that the HBM focuses mainly on the individual’s perceptions regarding certain health states and their outcomes (Rosental & Shmueli, 2021). It also explores how such beliefs determine one’s risks for performing or not performing healthy behaviors. The TPB is more closely related to intention and actual behavior than the TRA because of the inclusion of perceived behavioral control. Secondly, the TPB integrates social factors through subjective norms, which is not addressed in the HBM (Rosental & Shmueli, 2021). This inclusion makes the TPB even more complete in explaining social norms, pressures, and support for health behaviors. For instance, a patient’s prescription compliance can be primarily shaped by whether their kin and peers consider this behavior acceptable.

Thirdly, perceived behavioral control in the TPB is a much better factor than the HBM. While perceived barriers are included in the HBM, TPB takes it further by considering the ease or difficulty the individual feels about engaging in the behavior (Foroughi et al., 2022). This addition enables the researcher to perceive better factors that can enhance or hinder changes in behavior. Fourth, both models have good explanatory and predictive validity for health behaviors. Although the TPB partly increases the range of variables determining behavior by adding intention and perceived behavioral control. Shi et al. (2021) revealed that the TPB can predict a higher level of variance in health behaviors than the HBM, especially for behaviors. 

Applicability and Utility in Clinical Practice

In clinical practice, the applicability of both the HBM and the TPB is beneficial for designing interventions and enabling change in health behaviors. However, their applicability may differ depending on the context and Type of behavior being targeted. It can be used to build messages that help increase perceived susceptibility and severity and, at the same time, capture the gains of having preventive behaviors. For instance, the health belief model can be adopted in a public health campaign to encourage immunization by drawing the client’s attention to the dangers of not immunizing. 

Second, TPB is beneficial for behavioral counseling within clinical practice, as the model encompasses various cognitive-motivational factors influencing behavior. Self-report measures of the theory of planned behavior allow healthcare providers to determine the patient’s attitude, perceived norms, and perceived control interventions. For example, a smoking cessation program will embrace the TPB to increase self-efficiency for quitting smoking, maintain a positive attitude toward quitting smoking, and leverage tangible social support (Małecka et al., 2022). Thirdly, both models can be used to propose and assess health programs. HBM is suitable for the screening views of the patient and barriers since it mainly focuses on beliefs. The TPB detailed constructs provide resources on structuring interventions that can cover several factors affecting behavior. The assessment of the change in attitudes, subjective norms, and perceived behavioral control can be helpful in determining the effectiveness of programs and identifying opportunities for change.

Conclusion

In conclusion, the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) are practical frameworks that help comprehend and predict health behaviors. Both models highlight aspects such as attitude, social beliefs, and self-efficacy to instigate behavioral change. The consequences of the practice of nursing cannot be overstated. By applying these frameworks, nurses can plan for interventions that aim to change the patients’ beliefs, mobilize social support, and enhance self-efficacy, leading to better patient health. By incorporating these theories into clinical practice, more efficient approaches to health promotion and patient education are improved.