Models for Health Beliefs

A Nurturing Potential report

[Map courtesy of Hodges Health Career Model]


There are a number of psychological models, designed to predict and explain health behaviours and, in several cases, to propose prescriptions to arrest and replace those behaviours with more appropriately healthy alternatives.

We discussed one such model at great length in the second issue of our magazine, in 2002 ( where we did not merely describe the prescriptions for identifying the various stages of health behaviour, but also provided an article describing the processes by which the authors of the Model intended it to be utilised.

The Transtheoretical Model of Change (otherwise known as Stages of Change model)

This model, which has been applied to many areas outside that of health, was originally promoted as a means of identifying and replacing addictive behaviour, particularly drug and nicotine abuse.


The Health Belief Model

This model dates back to the 1950s and was initially developed in response to the failure of a free tuberculosis (TB) health screening program in the United States.  Since then it has been adapted to explore a variety of long and short-term health behaviours, including sexual risk and the transmission of HIV/AIDS.

The Model has been applied to a range of health behaviours and classes of subject.  Preventive health behaviours, for example, would include diet and exercising to promote good health; preventive measures such as vaccination and contraception; risk behaviours, such as smoking  and substance abuse; and clinical use by medical professionals.

Four perceptions serve as the main constructs of the model.  As illustrated above, these are Perceived Susceptibility, Perceived Seriousness, Perceived Benefits, Perceived Barriers.  A fifth construct of Self-Efficacy was subsequently added.

In principle, knowing what aspect of the Health Belief Model patients accept or reject can suggest appropriate interventions. For example, if a patient is unaware of his or her risk factors for one or more diseases, attention can be focused on informing them about personal risk factors. If the patient is aware of the risk, but feels that the behaviour change is overwhelming or unachievable, the focus can be on helping them overcome the perceived barriers

Self-efficacy refers to the extent of an individual’s belief in their abilities. It is based on feelings of self-confidence and control, and is a good predictor of motivation and behaviour. Recognizing and rewarding the patient for accomplishing tasks is a useful method of helping to build the esteem that is the basis of self-efficacy.



This section follows on naturally from the preceding description of the Health Belief Model to which it was added in an attempt better to explain individual differences in health behaviours.

The model was originally developed in order to explain engagement in one-time health-related behaviours such as being screened for cancer or receiving an immunization.  Eventually, the health belief model was applied to more substantial, long-term behavioural change such as diet modification, exercise, and smoking.  Developers of the model recognized that confidence in one's ability to effect change in outcomes (i.e., self-efficacy) was a key component of health behaviour change, and reflected a person's  ability to persist and to succeed with a task. As an example, self-efficacy directly relates to how long someone will stick to a workout regimen or a diet. High and low self-efficacy determine whether or not someone will choose to take on a challenging task or write it off as impossible.

Self-efficacy affects every area of human endeavour. By determining the beliefs a person holds regarding his or her power to affect situations, it strongly influences both the power a person actually has to face challenges competently and the choices a person is most likely to make. These effects are particularly apparent, and compelling, with regard to behaviours affecting health.

Most people can identify things they would like to change, things they would like to accomplish and goals they would like to achieve.  A person's self-efficacy will determine how successful they are likely to be in facing these challenges.

Although we have introduced this subject in connection with the health model to which it was related, it covers such a vast area of human endeavour that we propose treating it in a complete article in the next issue of Nurturing Potential.


The Precede-Proceed Model


[Source: Green & Kreuter 1991 - adapted by permission by Health Promotion in Canada]

The Precede-Proceed Model is a theoretical framework designed to help health promotion professionals to plan, structure and implement a programme of health promotion.  It also enables the evaluation of existing or developing programmes.

The Precede-Proceed framework for planning is founded on the disciplines of epidemiology; the social, behavioural, and educational sciences; and health administration. Throughout the work with Precede and Proceed, two fundamental propositions are emphasized: (1) health and health risks are caused by multiple factors and (2) because health and health risks are determined by multiple factors, efforts to effect behavioural, environmental, and social change must be multidimensional or multisectoral, and participatory

The name derives from its two progenitors: "PRECEDE" is actually an acronym that stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. It outlines a means for accurately diagnosing and planning a public health programme for a targeted community.  "PROCEED" is also an acronym for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. It facilitates the programmes designed as a result of the Precede process by guiding the implementation and evaluation of those Precede programs. While Precede works backward from the desired end result, attained through the diagnostic process, to the beginning point of the assessment process, Proceed works forward to implement the designed plan and to evaluate its effectiveness.

The PPM is very much an ecological approach to health promotion. The PPM is actually quite simple to understand once one realizes that it embodies two key aspects of intervention: a) planning, and (b) evaluation. The PPM guides the program planner to think logically about the desired end point and work "backwards" to achieve that goal. Through community participation, the planning process is broken down into objectives, step 3 sub-objectives, and step 4 sub-objectives. Conceptually, this approach to health promotion provides context to the use of theory, with theory being applied at the fourth step. This observation teaches a vital lesson, namely that programme planning is larger and is a more comprehensive task compared to the subservient function of theory selection and application.

Precede was devised in the 1970s, based on the premise that just as a medical diagnosis precedes a treatment, so should an academic diagnoses precede an intervention.   Proceed was added in 1991 to recognise environmental  factors as determinants of health and health behaviours.  In 2005 the model was revised again to reflect the growing interest in ecological and participatory approaches.

The Relapse Prevention Model

[Click on thumbnail for full size diagram]

This model calls for the identification of high-risk situations for relapse and the development of solutions that prevent a lapse (a single departure from healthy behaviour) from turning into a relapse (a return to an addictive lifestyle). 

A technique called Relapse Prevention Planning can can make all the difference.  By thinking ahead, and by working out ways to handle the pressures that might lead you back to your drinking, drug use or gambling, you can approach your new life with a greater sense of confidence.

Relapse Prevention Planning is based on the experiences and successes of many people who have travelled the road to recovery. It recognizes that the road often has many rough patches, and that to succeed on this road you will need a relapse prevention plan.  A lifestyle change, however,  is not easy to make or maintain.  Some people relapse several times before new behaviour becomes a regular part of their lives. Thus, it is important to learn about and use relapse prevention techniques. First though, it is helpful to understand the process of relapse.

Relapse Process

At some point after making a change, for instance stopping smoking or attending an addiction control group meeting,  the demands of maintaining it seem to outweigh the benefits of the change. We don’t remember that this is normal. Change involves resistance.

We feel disappointed. We forget—disappointment is a normal part of living. We feel deprived, victimized, resentful, and blame ourselves. We imagine that our old behaviour would help us feel better.

These are warning signs for a "lapse".  At this point talking to a supportive person, or some other form of distraction or relaxation could help relieve the pressure.

Cravings continue and increase.  There are so many reminders of our old behaviour.  People enjoying cigarettes or alcohol in a movie.  The cynical or demeaning comments of others.  It is so easy to lapse.  If we recognise that this is a natural reaction and we have a supportive person or a plan to distract us, we may succeed in stopping the lapse from become a relapse.  If we allow the guilt of our lapse to intensify, we will almost certainly relapse.

Relapse Prevention

Preventing relapse requires that we develop a plan that involves diversion activities, coping skills, and emotional support. Our decision to cope with cravings is aided by knowing: (1) there is a difference between a lapse and a relapse; and (2) continued coping with the craving while maintaining the new behaviour will eventually reduce the craving. These coping skills can make the difference when cravings are intense:

    Ask for help from an experienced peer and use relaxation skills to reduce the intensity of the anxiety associated with cravings.

    Develop alternative activities, recognize “red flags,” avoid situations of known danger to maintaining new behaviour, find alternative ways of dealing with negative     emotional states, rehearse responses to predictably difficult events, and use stress management techniques to create options when the pressure is intense.

    Reward yourself in a way that does not undermine your self-caring efforts.

    Pay attention to diet and exercise to improve mood, reduce mood swings, and provide added strength to deal with stressful circumstances and secondary stress symptoms, including loss of sleep, eating or elimination problems, sexual difficulties, and breathing irregularities.



Our descriptions of various health models have been pieced together from a variety of sources.  For further and more detailed information we can direct you to the following (non-exhaustive)  list:

Stages of Change model


The Health Belief Model

The Precede-Proceed Model

The Relapse-Prevention Model