Fundamentals - Principles, part 6: Health Belief and Transtheoretical Models

by Meris Shuwarger July 16, 2021 Updated: August 16, 2021

The Health Belief Model and the Transtheoretical Model are covered in Fundamentals of Nursing because they are, in fact, fundamental to nursing. As a nurse, you will have patients who need to change behavior to reach desired health outcomes, or because it would be dangerous to not change behavior. Diabetic patients will need to change eating habits to manage blood sugar, patients with emphysema will need to quit smoking, and more. Patients may or may not take action, and the process of change can be a gradual one.

Knowing the key facts about the Health Belief Model and Transtheoretical Model can help you understand and better work with patients who need to make a behavior change. This article covers the key facts on both of these models—to help you in your Fundamentals of Nursing studies and in clinical practice.

The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Health Belief Model

The Health Belief Model is a theoretical model used to explain and predict an individual's health-related behaviors.

Components of the Health Belief model

The Health Belief Model is made up of several important components: perceptions of severity, susceptibility, benefits and barriers; modifying factors; cues to action; and self-efficacy.

Perception of Severity

How severe does the patient perceive a potential illness to be? The less severe that we perceive a potential illness to be, the less likely we are to take action against it.

Perception of Susceptibility

How susceptible to an illness does a patient perceive themselves to be?

The less susceptible to something that we perceive ourselves to be, the less likely we are to take action against it.

It's important to note that these components of the Health Belief Model are often perfectly logical frameworks for decision-making. For example, if a problem is actually not very severe, it makes sense to take less action against it. The problem arises when there is a misperception of severity, or susceptibility, or benefits, etc.

Perception of Benefits and Barriers

How beneficial does a patient perceive the health actions to be? How many barriers, or how big of a barrier, to action does a patient perceive?

If we do not believe that making health changes or undergoing a treatment will be beneficial ("It's not going to help") we are understandably less likely to do it. Similarly, if we believe that making health changes or complying with treatments will come with huge barriers (time, expense, lifestyle change, social effects), we are less likely to take that action.

Modifying factors

Modifying factors in the Health Belief Model include age, gender, socioeconomic background, and more. All of these factors have the potential to change how someone views their own health.

For example, if a patient is 100 years old, they might make a different judgment call on what treatments or changes to make than a 40 year old patient would.

Cues to action

In the Health Belief Model, cues to action are external messages that either prompt or dissuade behavior.

For example, government officials, celebrities, athletes, and many more public figures have publicly advocated getting vaccinated against COVID-19. There have been public service announcements, commercials, door-to-door campaigns, billboards and more—these are all examples of cues to action. In the case of an individual deciding whether or not to get vaccinated against COVID-19, these cues to action have been part of their Health Belief model.

Self-efficacy

In the Health Belief Model, self-efficacy is an individual's confidence in their ability to be successful. How does a patient see themselves? Do they see themself as someone who puts their mind to something, takes care of it, and gets it done? Or do they see themselves as someone who probably won't be successful when they try to implement a change?

The more successful someone believes they will be at making a change, the more likely they are to take action to make the change.

How is the Health Belief Model used in nursing?

In nursing, this model helps us to understand why patients may or may not be compliant with their patient teaching or participating in their prescribed treatments or therapies. Understanding potential reasons for noncompliance can help you apply effective strategies to influence patients to make healthy lifestyle changes or comply with treatment plans.

Transtheoretical Model

The Transtheoretical Model is a theory that describes the six stages associated with health behavior changes.

Stages in the Transtheoretical Model

There are six stages in the Transtheoretical Model: precontemplation, contemplation, preparation, action, maintenance, and termination.

Precontemplation

In the Transtheoretical Model, the precontemplation stage is before the patient has begun contemplating a change. The patient is not aware of a change that needs to be made. In this stage, it is unlikely that the patient will make a change in the next 6 months.

Contemplation

In the Transtheoretical Model, the contemplation stage begins when the patient has been made aware that they need to make a change. This means the patient is now thinking about it (contemplating). In this stage, it's likely that they will make a change in the next 6 months.

Preparation

In the Transtheoretical Model, the preparation stage is when the patient is preparing to make the change. This patient might be taking some small beginning action steps. During the preparation stage, the patient is likely to make the change in the next 30 days.

Action

In the Transtheoretical Model, the action stage is when the change has been made sometime within the last 6 months and the behavior is ongoing.

Maintenance

In the maintenance stage of the Transtheoretical Model, the patient has made the change and persisted with it for 6 months or more, and is continuing.

Termination

In the termination stage of the Transtheoretical Model, the patient has made a change and it's considered permanent—the desire to return to the previous behavior is gone. What is actually being terminated in this stage is the old behavior—it has been extinguished, and the change is the new normal.

How is the Transtheoretical Model used in nursing?

In nursing, it's important to identify which stage your patient might be in, when it comes to a health or behavior change. Understanding their stage of change can help you apply appropriate strategies to influence behavior towards desired health outcomes. This can help to "meet someone where they are," and provide strategies that will be most effective now, rather than strategies that might be helpful in the future, but aren't quite yet.


Full Transcript

Hi. I'm Meris. And in today's video, we're going to be talking about the Health Belief Model and the Transtheoretical Model. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on levelupRN.com. So if you are following along with me with your cards, I'm starting on card number 16. Let's get started.

So first up, we're talking about the Health Belief Model. And this is used to explain and predict an individual's health-related behaviors. So, for instance, an individual is not likely to take action against a disease or a condition if they perceive it as not being severe and perceives themselves as not being susceptible.

So, for instance, if I have no experience with Type 2 diabetes, no one in my family has had it, I don't, I've never seen somebody with it, I kind of maybe don't perceive it as being that big of a deal. And I probably don't perceive myself as being at risk for it. On the flip side, if a lot of people in my family have had it, and I've seen firsthand how severe it has been for them, I'm going to perceive myself as being more likely to get it and aware of the possible severity of this condition.

That may motivate me to take action against it versus someone who doesn't see it that way.

There's also benefits and barriers to taking action. If I only need to change a behavior slightly, I'm probably more likely to do that. But if taking action against a disease is going to require extensive lifestyle modifications, I'm probably not willing to make that change, or it's going to take a lot more motivation to get me to make that change. Other things would be modifying factors like age, genetics, gender. All of those sorts of things may change how the individual views their own health.

And then we also have cues to action, which are things like, what is the message we're getting from society? Am I seeing a lot of public service announcements about it? Am I seeing billboards? Am I aware of the significance of a condition or a disease? That's going to change how I perceive it as well.

One more thing is going to be self-efficacy. And self-efficacy describes a person's ability or willingness in their ability to be successful. So how do I see myself? Do I see myself as someone who puts their mind to something and takes care of it, and I get it done? Or do I see myself as someone who's probably not going to be successful when I try to implement a change? Just how I perceive myself is going to change my ability to be successful in making that change.

Okay. On card number 17, we talk about the Transtheoretical Model. And you can see here, I have a nice table on this card. I've got a lot of bold and red information. So there's a lot to know from this card. But the Transtheoretical Model describes the six stages associated with behavior change.

So let's say I just found out that I am prediabetic, and the doctor says, "Hey, we can keep you from getting Type 2 diabetes, but these are the steps you need to make. You need to eat fewer carbs, and you need to be more active."

Okay. Wow. Well, there's a lot-- it's not as simple as just flipping the switch and making that change. So, first of all, we have the Pre-contemplation Stage. Pre, meaning before; contemplation, meaning thinking about. So this is before I'm even thinking about it. This means that I'm not aware of a change that needs to be made. Maybe this was before I went to my doctor. And it's unlikely that I'm going to make a change in the next six months, if I'm in this stage.

After that, though, now I'm aware of it. I know that there's a change that needs to be made. Now I'm in the Contemplation Stage. This means I'm thinking about it. So now I'm thinking about making a change. It's likely I'll make this change, but within the next six months.

Moving on with the Preparation Stage. As the name might suggest, this means I'm preparing to make the change, maybe making some small changes, little baby steps. This is good, though, and it indicates that within the next 30 days, I might be making that change.

After preparation comes action. This means I've made the change and the behavior is ongoing.

Maintenance, as the name might suggest, maintenance means I'm maintaining that change. So I made the change, it's ongoing, and the change has persisted for six or more months. That's a long amount of time to make a change.

And then the last stage, of course, being termination. This means that the desire to return to my previous behaviors is gone. The change is considered permanent. It's just a lifestyle modification that I have successfully made.

So that's the Transtheoretical Model. Very helpful in understanding how to engage your patients and how to help them in making behavior change.

Okay, that is it for the Health Belief Model and the Transtheoretical model. I hope that was helpful. If it was, please like this video. I would love for you to leave me a comment below.

Tell me what you thought about this video, or what else you would like to add. If there's any cool way you remember things from this video, definitely let us know.

Next up, I'm going to be talking about communication. Communication is so important for fundamentals, so you don't want to miss that. Make sure you subscribe to the channel so you get notified as soon as new content comes out. I can't wait to see you in the next one. Thanks so much, and happy studying!


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