PU505: Health Behavior Unit 5 Health Belief Model Flashcards
What is the essence sentence of the health belief model?
Personal beliefs influence health behavior
What are the constructs of the health belief model? (7)
Perceived:
- Susceptibility - personal belief about the chances of getting the disease
- Benefits - personal belief about whether the new behavior is better than what is already being done
- Seriousness - personal belief about the severity of the disease
- Modifying variables - personal factors that affect whether the new behavior is adopted
- Cues to action - factors that start a person on the way to changing a behavior
- Self-efficacy - personal belief in one’s own ability to successfully do something
What is the short and sweet why HBM was developed?
In the 1950s, public health practitioners wanted to know why people were not entering screening programs for disease prevention and early detection of TB.
The outcome of the study identified three sets of factors that determined participation in a voluntary screening program: psychological readiness, situational influences, and environmental conditions (Rosenstock, 1958).
Factors identified as being indicative of people’s psychological readiness to be screened for TB included the belief that they had TB, were at risk of getting TB, or that they would benefit from being tested for TB.
Situational influences included having bodily changes thought to be symptoms of TB, other people’s opinions of whether they should or shouldn’t be screened, and lastly, if environmental conditions provided an opportunity to be screened, and if it was convenient (Rosenstock, 1958).
The conclusions drawn from this study formed the basis of the HBM.
What is the theoretical concept of the HBM?
Personal perception is influenced by the whole range of intrapersonal factors affecting health behavior, including, but not limited to knowledge, attitudes, beliefs, experiences, skills, culture, and religion.
For HBM, what are the four constructs, either individually or in combination, that can be used to explain health behavior?
Perceived susceptibility, perceived seriousness, perceived benefits, and perceived barriers.
What is a personal belief of the chance of getting a disease?
Perceived susceptibility.
It’s a perception of risk, rather than the actual risk, that is tied to the likelihood of engaging in risk reducing behaviors.
Risk perception and actual risk are rarely the same. For example, in Scandinavia, the incidence of Lyme disease is increasing. Because it’s a relatively new disease in many areas, involuntarily contracted, difficult to control, and has potentially devastating consequences, people perceive they have a 20% risk of developing it after a tick bite. In actuality, the risk of disease is about 2% (Slunge et al., 2019).
In this situation, if overestimation of risk results in adoption of and adherence to risk reducing behaviors, such as avoiding tall grasses, using tick repellant, wearing light colored clothing, this is a welcome outcome. However, overestimation of risk could just as easily result in people reducing the time they spend outdoors in nature or engaged in activity. Underestimation can be equally as concerning, as it can reduce the likelihood of adopting risk reducing behaviors (Slunge et al., 2019). Another example of risk perception and actual risk being miles apart is what a study of more than 4,000 people in the United States revealed. In this case, people at high risk for diabetes, breast cancer, and colorectal cancer underestimated their risk of developing these diseases up to 75% of the time and those at low risk overestimated their risk up to 40% of the time (Brawarsky et al., 2018).
Risk perception, within the construct of perceived susceptibility, is influenced by factors such as? (9) (Harvard Mental Health Letter, 2011; Ropeik, 2002)
Examples of these influences -
Early in the HIV epidemic, Asian American college students tended to view the epidemic as a non-Asian problem. As a result, their perception of susceptibility to HIV infection was low and so was their practicing of safer sex behaviors (Yep, 1993).
Similarly, adolescents and young adults in Canada perceived their risk of contracting COVID-19 as being lower than that of their family and friends. When a large sample of 14 to 22-year-olds were asked to assess their risk of contracting COVID-19, they perceived their risk as 5.6 on a 10-point scale and their family and friends’ risk at 8.2. However, in contrast to the low perceived risk of HIV resulting in a low adoption rate of preventative behaviors discussed previously, the majority of the Canadian adolescents and young adults reported adhering to COVID-19 preventative measures (Yang et al., 2020).
In an international study involving more than 6000 people from 10 countries, the perception of susceptibility to COVID-19 was associated with the adoption of preventative behaviors. Risk perception was measured by questions that addressed the extent of worry about coronavirus, the likelihood of contacting the virus, or of family or friends contracting it, and the seriousness of the virus. The responses showed a high perception of risk that was related to an equally as high adherence to the preventative behaviors of handwashing, mask wearing, and social distancing (Dryhurst et al., 2020).
However, sometimes the relationship between risk perception and adoption of preventive behaviors does not hold true as was the situation at the end of the first month of the COVID-19 pandemic in the United States in March 2020. A national survey conducted at the time of more than 700 adults found that although they perceived a 30% to more than 40% chance of contracting COVID-19 during the next month, 35% reported they did not follow social distancing recommendations (Masters et al., 2020).
Trust - When people trust the source providing information about a risky situation, they tend to be less afraid. When they have less trust in the information source, they tend to be more afraid of the risk situation.
For example, information about a cancer prognosis is less frightening when it comes from an oncologist rather than from someone at a bar.
Risk Origin - When people are involuntarily exposed to a risk, they are much more afraid of the consequences than when they voluntarily expose themselves to the risk.
For example, people are less afraid of driving while texting than they are of driving next to someone who is driving while texting.
Control - When people feel they are in control of a risk situation, they are much less afraid of the outcomes than when they don’t feel they are in control.
For example, people are less afraid of the consequences of driving than they are of flying even though car accidents cause thousands of deaths a year compared to plane crashes.
Cause - People are less fearful of a risk situation in nature, such as sun exposure than a human-made hazards such as a nuclear power accidents.
Scope of Consequences - Events capable of killing many people violently, suddenly, and at the same time are more frightening than chronic health conditions that may kill the same number of people but over a longer period of time.
For example, the consequences of a tsunami are perceived as being more frightening than the consequences of heart disease.
Dread - The more dire or worse the consequences of a risk, the greater the fear. For example, the risk of being eaten alive by a shark or drowning lead to a greater perception of risk.
Seeing and Understanding - People tend to perceive a greater risk from things they don’t understand or can’t see more than those they do understand or can see.
Familiarity - People perceive new risks as more dangerous than familiar ones. For example. the risk of the flu is perceived as less dangerous than the risk of COVID-19.
Age - The younger the possible victims of the risk situation, the greater the perception of risk. For example, asbestos in a school is more feared than asbestos in a factory.
Media Awareness - When there is extensive media coverage of a situation, the perception of personal risk increases.
More underestimating and overestimating risk
Pregnancy is another example of the consequences of underestimating risk. When 237 Vietnamese women were asked about their perceived risk of unintended pregnancy, 68% rated their risk as highly unlikely, although the majority of them relied on male condoms for contraception (Londeree et al., 2020), which have a use failure rate of 15% (Planned Parenthood, 2021). Interestingly, the women most concerned about becoming pregnant were the ones who underestimated their risk the most (Londeree et al., 2020).
The underestimation of susceptibility to sexually transmitted infections (STIs) or unrealistic optimism is fairly common among older adults (Ferrer & Klein, 2015). This is particularly concerning since the rates of STIs among adults 55–64 years old in the United States increased substantially between 2014 and 2018. Chlamydia rates rose overall from 16.3 cases per 100,000 in 2014 to 29.9 per 100,000, with the rate among men more than doubling from 20 per 100,000 to 41.8. Gonorrhea rates also more than doubled during this time from 11.4 per 100,000 in 2014 to 28.8 in 2018, with the rates among men increasing from 20 to 51.3 (Centers for Disease Control and Prevention [CDC], 2019a). Despite this, older adults generally don’t see themselves as being at risk of STIs, and consequently they tend not to use condoms for vaginal or oral sex or get tested for STIs (Syme et al., 2017).
When those at low risk of developing a chronic disease overestimate their risk and adopt risk reducing behaviors, it’s not a bad thing. For example, when people of average weight overestimate their risk of developing diabetes and adopt a more plant-based diet and eliminate highly processed foods, it not only keeps their risk of diabetes low, it lowers their risk of cardiovascular disease and cancer as well. However, when people at high risk underestimate their risk, it’s concerning because a more accurate assessment of susceptibility is needed for the adoption of health promoting lifestyle behaviors and adherence to medication treatments (Cainzos-Achirica & Blaha, 2015).
This was the situation found among women in Saudi Arabia regarding their cardiovascular disease risk factors, in particular obesity, physical inactivity, and smoking. Over a 10-year period, obesity rates among Saudi women almost doubled, increasing from 23.6% to 44%, self-reported physical inactivity increased from 88% to 98%, and smoking increased from less than 1% to almost 8% (AlQuaiz et al., 2014).
When almost 400 female teachers from 10 different schools in the Saudi capital of Riyadh were surveyed about their perception of susceptibility to cardiovascular disease, results showed that 76% were inactive, 54% obese, and 44% had a family history of heart disease. However, only 13% of those who were inactive, 17% of those who were obese, and 21% of those with a family history of heart disease perceived themselves to be at risk of cardiovascular disease. Stated another way, 87% of the inactive women, 83% of the obese women, and 79% of those with a family history did not believe they were at risk of cardiovascular disease although they were. Consequently, the underestimation of their susceptibility to heart disease did not support their likely adoption of healthier behaviors (Al-Tamimi & Bawazir, 2020) which underscores the reality that until women believe they are at risk of heart disease, efforts to change their behavior will continue to be hampered (Robertson, 2001)
What can the construct of perceived seriousness be based upon in an individual’s life?
For some people, the perception of seriousness is based on medical information or knowledge; for others it’s based on how the disease might affect their families, jobs, or other aspects of their lives (Rosenstock, 1974).
The construct of perceived seriousness or severity speaks to individuals’ beliefs about the gravity of possible consequences of a disease as they pertain to some aspect of their lives, the basis of which varies from person to person.
As an example, many people perceive seasonal flu as a relatively minor annoyance. You get it, stay home from work or school for a few days, and get better. However, if you have a chronic respiratory disease such as asthma or bronchitis, contracting the flu could land you in the hospital. In this case, the flu might be perceived as a much more serious disease. In the case of a self-employed or gig worker, having the flu might mean a week or more of lost wages, which would color the person’s perception of its severity.
Perceived seriousness construct examples
In Beijing, the perception of flu severity impacts vaccination rates. People who perceive the flu to be a serious disease are more likely to be vaccinated than those who do not (Wu et al., 2017). Similarly in Australia, people who perceive the flu to be very severe—that is, they rate it between 7 and 10 on a 10-point scale—are significantly more likely to be vaccinated than those who perceive it to be less severe (Trent et al., 2021).
The perception of the severity of lung cancer among current and former smokers attending outpatient clinics in Australia was a driving factor in their preference to undergo screening with low dose computed tomography (low dose CT scan) (See et al., 2020). Interestingly, although the perception of lung cancer severity motivates people to be screened, screening may actually lower their motivation to quit smoking. This can happen if people interpret screening as a preventative action against lung cancer in that it will catch it early before significant treatment is needed, or if they interpret a negative screening as an indication of being a “lucky one” who can smoke and not suffer detrimental effects (Zelidat et al., 2015).
The perceived seriousness of lead contamination among residents in three communities near or in a superfund site in northern Idaho was associated with their intention to adopt lead poisoning prevention behaviors. The greater the residents’ perceived seriousness of lead contamination, the greater their intention to promptly remove dirt from clothes, pets, cars, and toys after spending time outdoors, wash hands with clear water before eating, drinking, or after being outdoors, and use a blanket or other protective barrier when sitting on a sandy beach (Cooper et al., 2020).
The high incidence of cervical cancer among women in Nigeria coupled with the limited capacity to treat advance disease are significant issues that could be improved by increasing cervical cancer screening. To this end, more than 1,000 women living in a large, diverse city were surveyed about their perception of the seriousness of cervical cancer and their screening history, among other factors (Ilevbare et al., 2020).
The results showed that perception of seriousness influenced screening behavior. Women who perceived cervical cancer as less serious were 41% less likely to have been screened than were women who perceived it as highly serious. These results suggested a need for educational programming focused on correcting misconceptions about the consequences of untreated cervical cancer (Ilevbare et al., 2020) and the important role screening plays in its early diagnosis.
Perceived seriousness is also a factor in colorectal cancer screening in the Netherlands, as an online survey of more than 1,600 adults found. In this example, perceived severity was determined by the extent to which survey participants agreed with the following statements: Cancer is very serious, cancer has major consequences, cancer is very treatable, cancer means the end of your life, cancer is impossible to prevent, and cancer is more serious than any other disease (Douma et al., 2018).
The survey results showed that almost all respondents totally agreed with the statements about the severity of colorectal cancer, deeming it a very serious disease. In addition, the perception of seriousness was related to their positive attitude toward preventive screenings, which was not surprising given that there is a 73% participation rate in the government-sponsored colorectal screening program (Douma et al., 2018).
As the previous examples show, perception of seriousness can and does influence health behavior. Usually, the more severe or serious a disease is perceived to be, the more likely it is that people will take action to prevent it.
What is a combination, and also a construct within HBM, of perceived susceptibility to a disease and perceived severity of the disease?
Perceived threat.
When people believe they are susceptible to a serious disease, it’s likely their behavior will change. However, if they believe they are susceptible to a nonserious or mild disease, or they believe they are not susceptible to a serious disease, then it’s unlikely their behavior will change (Skinner et al., 2015).
Information on perceived threat construct
An example of how the perception of disease threat relates to the adoption of health-promoting behaviors occurs during the annual Hajj. Hajj is the Muslim religious pilgrimage to Mecca, Saudi Arabia. Considered the pinnacle of the Islamic faith, it is undertaken at least once in a Muslim’s lifetime (Embassy of the Kingdom of Saudi Arabia, n.d.). The challenges of safeguarding the health of more than 2 million Muslims each year during the Hajj are substantial, given that social distancing and contact avoidance are difficult, if not impossible, with the sheer number of people attending and the various rituals required of them each day (Taibah et al., 2020).
The threats to the health of Hajj attendees include heat stroke, diarrhea, vomiting, pre-existing conditions, and epidemics. In an effort to prevent these health problems, local governments in host countries use education and information campaigns to encourage Hajj pilgrims to adopt health-promoting behaviors. These include bringing medication from home, being vaccinated prior to traveling, maintaining personal hygiene, using hand sanitizer, and washing hands (Taibah et al., 2020).
Of the health issues facing the Hajj pilgrims in 2017, they identified heat stroke as the greatest perceived threat. This is not surprising since Hajj took place between August 30 and September 4, when daytime temperatures in Saudi Arabia were as high as 110°F (43°C) (Taibah et al., 2020).
The perception of threat of heatstroke and complications from preexisting conditions were strongly related to people maintaining personal hygiene and washing their hands. The perceived threats from vomiting, diarrhea, preexisting conditions, and epidemic outbreaks was strongly related to people bringing medication from home and getting vaccinated prior to traveling (Taibah et al., 2020). In this situation, the perception of threat was directly related to the adoption of preventative health behaviors.
Low threat perception exacerbated a problem with leptospirosis in Malaysia. Leptospirosis is a bacterial infection that’s spread to people through the urine of infected animals, both domestic and wild, including rodents, dogs, horses, and cattle. Untreated in humans, it can lead to kidney damage, meningitis, liver failure, and in some cases, death (CDC, 2019b). It emerged as a public health concern in Malaysia in 2015 with an incidence rate of 30.2 per 100,000 (Sukeri et al., 2020) compared to a worldwide rate of 14.77 per 100,000 (Costa et al., 2015). The areas with the greatest problems were facing waste management issues and rising rodent populations from rapid urbanization (Sukeri et al., 2020).
Although people living in these areas perceived leptospirosis to be a serious or very disease most importantly because of the risk of death, their perception of susceptibility was underestimated. Most did not believe they were at risk of contracting it (Sukeri et al., 2020) even though they lived in areas where disease rates and risks factors were high.
A plausible explanation is that a lack of knowledge contributed to the low perceived susceptibility and, in turn, a low perception of threat. Although perception of severity was high, it wasn’t enough on its own to influence preventative health behaviors (Sukeri et al., 2020).
A similar situation was found in Singapore. Even though people perceive dengue fever to be a serious illness, vaccination rates remain low. A possible explanation for this is that while the perception of seriousness is high, the perception of susceptibility is low (Panchapakesan et al., 2018).
In Iran, perception of threat of hepatitis B is predictive of Iranian healthcare workers hepatitis B vaccination status. Contracting hepatitis B virus is the most common occupational hazard for healthcare workers in Iran with incidence rates of up to 10 times that of the general public. Vaccination of high-risk groups, which include healthcare workers, began in 1993 (Alavijeh et al., 2019). Despite this initiative, the results of a 2015 study found rates of vaccination among this group as low as 53% in some areas of the country (Sayehmiri et al., 2015). In an effort to increase vaccination rates specifically among the nurses, it was important to first identify the ways in which vaccinated and unvaccinated nurses differed (Alavijeh et al., 2019).
As it turned out, vaccinated nurses were more likely female, had family or friends with a history of hepatitis B, and importantly, perceived hepatitis B to be a greater threat than did the unvaccinated nurses. Based on this, it seemed reasonable to assume that if the nurses’ perception of hepatitis B threat was increased, their vaccination rates would also increase (Alavijeh et al., 2019).
A troubling behavior among Korean high school students is the use of highly caffeinated drinks to stay awake while studying for exams, in an effort to increase academic achievement and earn admission to prestigious universities. Unfortunately, these drinks come with unwanted side effects. In excessive amounts, they can result in irritability, anxiety, depression, sleeplessness, and elevated blood pressure, among other physical and psychological problems. To address this issue, it was first necessary to identify factors associated with their use (Ha et al., 2017).
Data were gathered from more than 800 high school students about their perceived threat from drinking highly caffeinated drinks. Threat perception was determined by assessing the students’ perception of susceptibility to the health problems, diseases, and injuries that can result from consuming highly caffeinated drinks and their perceptions of seriousness by assessing the extent to which they believed the effects of consuming these drinks were severe or minor (Ha et al., 2017).
The more susceptible students believed they were to the negative effects of consuming highly caffeinated drinks, the less they used them. Similarly, the more serious students perceived the effects of consumption, the less they used them. Students who perceived these drinks to be a greater threat, were less likely to use them.
However, 54% of students who used these drinks did not perceive them to be a health threat (Ha et al., 2017). The perception of low threat resulted in the continued unhealthy behavior of consuming these drinks. What’s interesting is that 28% of the students who drank these beverages believed they were a severe health threat (Ha et al., 2017). Perhaps they drank them because even though they were at some risk of the negative effect, based on their experience, they were not at great enough risk of the negative effects to stop.
Hayden, Joanna. Introduction to Health Behavior Theory (p. 168). Jones & Bartlett Learning. Kindle Edition.
What construct within HBM revolves around the idea that a person’s opinion of how useful or valuable a new behavior is, how much good it would do in decreasing the risk of developing a disease or an illness?
Perceived benefits.
Would people strive to exercise if they didn’t believe it was beneficial? Would people quit smoking if they didn’t believe it was better for their health? Would people use sunscreen if they didn’t believe it worked? Probably not.
Perceived benefits construct information
Over a 10-year period in Saudi Arabia, the obesity rates among women increased from 24% to 44%, and inactivity from 85% to 98%, putting them at higher risk for cardiovascular disease. In an effort to address this, researchers examined the health beliefs and health-promoting behaviors related to cardiovascular disease among female teachers in the capital city of Riyadh (Al-Tamimi & Bawazir, 2020).
The results of this inquiry showed that 98% of the teachers scored high on perceived benefits of adopting heart healthy behaviors and were 26 times more likely to adopt them than were those with low perceived benefits scores. Interestingly, although 94% of the teachers perceived physical activity as beneficial for the prevention of heart disease, only 24% participated in physical activity on a regularly basis (Al-Tamimi & Bawazir, 2020).
Self-care behaviors are key to the control of high blood pressure. These behaviors include taking medication as prescribed and making lifestyle modification such as a low sodium diet, regular physical activity, weight management, smoking cessation, stress reduction, and regular blood pressure monitoring. However, in China adherence to these is abysmal among young and middle-aged adults (Ma, 2018).
In an effort to change this situation through health education programing, a study of more than 300 people was conducted to identify factors related to the self-care behaviors. The results showed perceived benefit is the strongest predictor of medication adherence from among all the constructs of the health belief model (Ma, 2018). Given these results, a health education program focused on the benefits of taking medication as prescribed to control high blood pressure seems appropriate.
In earthquake prone areas, earthquake preparedness is key to saving lives when these unexpected disasters hit, often with little to no warning. While it’s logical to assume people living in these areas would be prepared, they aren’t always, as is the case in Iran.
Iran’s geographic location puts more than 70% of its major cities at risk of substantial damage from an earthquake. This statistic alone is alarming, but even more so considering that the populations in these areas are ill-prepared for such a disaster (Rostami-Moez et al., 2020).
Earthquake preparedness entails knowing first aid and having a first aid kit, having a flashlight, extra clothes and blankets, plastic bags and toilet paper (for a make-shift emergency toilet), and fire insurance. Before making any attempts to increase preparedness, it was first necessary to understand why people weren’t prepared and to identify factors that could predict preparedness (Rostami-Moez et al., 2020).
To this end, 1,000 people living in nine counties in the western part of the country were surveyed. Data were collected about their preparedness knowledge and behaviors, their perceptions of the seriousness and severity of an earthquake, the benefits of and barriers to preparing for such an event, cues to action, and the extent of their self-efficacy (Rostami-Moez et al., 2020).
The results showed that households were about 30% prepared. Of all the constructs of the HBM measured, perceived benefits, cues to action and self-efficacy were significantly associated with, and predictive of, preparedness. preparedness. It’s possible that when people are aware of the benefits of earthquake preparedness, feel confident in their ability to prepare, and have external prompts from friends, family, and the media, they are more likely to prepare. Knowing this provided a basis for the design and implementation of educational programs to improve earthquake preparedness among people living in at risk areas (Rostami-Moez et al., 2020).
During the COVID-19 pandemic, it was imperative for countries around the world to reduce the strain on their healthcare systems and slow the spread of the virus. Citizen compliance with public health recommendations was key to this. However, compliance with risk-reducing behaviors, such as social distancing and home quarantining, were difficult to enforce, especially in democratic countries (Clark et al., 2020).
Because of the importance of getting people to voluntarily comply with the public health recommendations, it was necessary to identify the beliefs or perceptions related to compliance. To this end, more than 8,000 people from 70 different countries were surveyed (Clark et al., 2020).
The beliefs associated with the intention to comply with the public health recommendations were determined by the extent to which survey participants agreed with statements that reflected their perception of the benefits of complying. They included that avoiding crowds is effective for avoiding COVID-19, staying home is effective, social distancing is effective, frequent handwashing is effective, and wearing a mask is effective for avoiding COVID-19 (Clark et al., 2020).
The extent of agreement with the following statements measured perceived susceptibility: I am less likely to get COVID-19 than most people, I am not at risk, my body could fight it off, people like me don’t get it, there is little chance of me getting it or spreading it from what I do. Perceived seriousness was measured by the extent of agreement with the following statements: having COVID-19 would be disruptive to my life, my physical health, and my social life (Clark et al., 2020).
The results of the survey showed that agreement with the statements about the benefits of the recommendations and being concerned about ones’ health were predictive of compliance with the public health recommendations. Although one would expect perceived seriousness and susceptibility of COVID-19 to have influenced compliance with preventative measures, they did not (Clark et al., 2020).
The practical application of knowing this information lies in its usefulness in developing programs. Clearly from these results, programs should focus on the benefits of the risk-reducing behaviors rather than the risk of contracting COVID-19 or its severity (Clark et al., 2020).
Even when change is perceived as beneficial, what construct of the HBM addresses the issue when change does not happen and the obstacles a person believes is stopping them from taking a recommended action? (Rosenstock, 1974).
Perceived barriers.
It is the most significant construct in behavior change (Janz & Becker, 1984).
When individuals believe obstacles are stopping them from changing their behavior, this not only negatively impacts their personal health, but it can and does impact the public’s health, as well. This is the situation with avian influenza in Bangladesh. See information on perceived barriers.
What are events, people, or things that move people to change their behavior?
Cues to action
Examples include illness of a family member or friend; newspaper, magazine, or online articles; reminder emails or mailings from a healthcare provider; or health warning labels on a product.
For some women, developing gestational diabetes is a cue to action for behavior change to decrease the risk of developing type 2 diabetes (Tang et al., 2015). For others, it might be having an overweight friend diagnosed with type 2 diabetes or a healthcare provider’s warning.
With an estimated 70% to 85% of annual deaths from flu occurring in people 65 and older, vaccination is key for prevention in this age group (CDC, 2021). For older adults in nine different countries, the most important cues to action for flu vaccination are recommendations from medical personnel, family members, friends, and neighbors; information about flu vaccination from mass media; and public health education (Kwong et al., 2010).
Hayden, Joanna. Introduction to Health Behavior Theory (p. 184). Jones & Bartlett Learning. Kindle Edition.
What is the belief in one’s own ability to do something?
Self-efficacy
This is important because people generally don’t try to do something new unless they think they can do it even when they perceived it to be beneficial.
What is the relationship of HBM constructs in a flow-type diagram?
Modifying variables is susceptibility, seriousness, and perceived threat to include the benefits minus the barriers and cues to action to equal behavior.
