The Health Belief Model Theoretical Application Assignment

THEORETICAL APPLICATION 8

Theoretical Application Assignment

Part One: The Health Belief Model and HPV Vaccination Uptake among Young Adults

Cervical cancer is a fundamental health concern for nations globally. The World Health Organization (WHO) recommends the human papillomavirus (HPV) vaccine as an effective way to prevent HPV-related conditions, including cervical cancer (Alsulami et al., 2023). The vaccine is available for young children aged between 9 and 12, although young adults aged between 13 and 26 could also receive a catch-up immunization if they did not begin or complete the vaccination series before age 12 (Alsulami et al., 2023). According to Kamolratanakul and Pitisuttithum (2021), the HPV vaccine is 80 percent effective in preventing HPV-related infections. However, the uptake of the HPV vaccine among young adults in the United States and globally remains low. The health belief model provides a framework for understanding the possible reasons for this trend.

The Health Belief Model

The health belief model postulates that the decision to screen for, prevent, or control illnesses depends on an individual’s perceived susceptibility to the disease, perceived seriousness, perceived benefits and barriers, cues to action, and self-efficacy (Alsulami et al., 2023).

Perceived Susceptibility

This is a measure of an individual’s belief that they can contract the disease (Alsulami et al., 2023). Young adults are more likely to get vaccinated if they believe they are at-risk of getting infected with HPV (Calderon-Mora et al., 2020). Calderon-Mora et al. (2020) conducted a study of 599 women in the US to identify the psychosocial factors that influence HPV vaccination rates. Of the 599 women, only 93 (representing 15.5 percent) believed that they were at-risk of getting HPV, and only 13 percent believed that they were likely to get such an infection in the near future (10 years). In another study by Donadiki et al. (2014) approximately 30 percent of female university students in Greece did not see the need to get vaccinated because they did not believe the vaccines were effective in preventing cervical cancer and other conditions. Moreover, 92.5 percent did not get vaccinated because they believed their sexual behavior was safe and hence, they were not at-risk of getting HPV. Donadiki et al. (2014) conclude that there is a need to intensify efforts to increase knowledge of the overall nature of HPV and susceptibility among young adults as a way of encouraging more to get vaccinated.

Perceived Seriousness of HPV Infections

Perceived seriousness is a measure of how serious an individual perceives a disease and its consequences to be (Calderon-Mora et al., 2020). Young adults are more likely to get vaccinated if they believe HPV is bad for their health. In their study, Calderon-Mora et al. (2020) found that a majority of women in the US, over 86 percent, agreed that HPV would disrupt their physical health, romantic relationships, and overall quality of life. However, Donadiki et al. (2014) found that approximately 20 percent of university students did not understand the potential harms of HPV or that failure to obtain the vaccine increased the risk of getting cervical cancer or genital warts. This lack of awareness on the severity of HPV and its consequences reduces young adults’ inclination to get vaccinated.

Perceived Benefits

Perceived benefits has to do with how much one believes that taking a preventive action will reduce the risk of acquiring an illness (Donadiki et al. 2014). In the context of HPV, the perceived benefits construct focuses on how much one believes that the vaccine reduces the risk of serious consequences. The study by Calderon-Mora et al. (2020) found that most young adults have a good understanding of the perceived benefits of the HPV vaccine. For instance, 86 percent of participants believed vaccination would help them lead healthier lives. At the same time, only 72 percent of participants believed the vaccine’s benefits outweighed the risks (Calderon-Mora et al., 2020). Donadiki et al. (2014) reported a similar finding from a sample of female university students in Greece - 45 percent of young adults interviewed did not believe the HPV vaccine was safe, while 49 percent did not believe that taking the vaccine would protect them against cervical cancer. Generally, the study found that participants who scored higher on the specific benefits measure were more likely to be vaccinated (Donadiki et al., 2014). Thus, the authors conclude that there is need for more advocacy through public health education programs to address attitudes and risk perceptions about the vaccine. Such programs would also help spread positive information about the benefits of HPV vaccination to increase uptake among young adults (Donadiki et al., 2014).

Perceived Barriers

Perceived barriers are the psychological or physical factors that prevent young adults from getting the HPV vaccine. According to Calderon-Mora et al. (2020), the most common barriers preventing vaccine uptake were lack of adequate information on the vaccine, accessibility, and cost. For instance, 82 percent of parents with female children and 88 percent of those with male children indicated that they would get the vaccination if it was offered free or at a very low cost (Calderon-Mora et al., 2020). Donadiki et al. (2014) also found that young adults who lacked insurance coverage were less likely to get vaccinated due to cost-related reasons. At the same time, 56 percent parents who took part in the study by Calderon Mora et al. (2020) indicated that they did not know where to get the vaccine for their children.

Donadiki et al. (2014) additionally found that factual misconceptions among young adults prevented them from getting vaccinated. For instance, participants in stable relationships and those with a single sexual partner were less likely to get vaccinated because they believed they were not at risk of getting HPV (Donadiki et al., 2014). Also, participants who did not believe in the efficacy and safety of vaccines generally or who did not believe the vaccine would prevent them from getting HPV infections were more likely to refuse vaccination (Donadiki et al., 2014). This indicates that generally, young adults may refuse to get vaccinated because of misperceptions about their susceptibility, severity of HPV, and the benefits of the HPV vaccine.

Parental consent also emerges as a significant barrier to vaccine uptake among young adults. Calderon-Mora et al. (2020) found that young adults whose parents consented to the vaccine were more likely to get vaccinated than those who lacked parental consent. Thus, the study recommends more educational programs targeting parents to address misconceptions and concerns surrounding the safety of the vaccine.

Cues to Action

These are the actions that could help motivate the target population to engage in preventive behavior, which, in this case, is getting the HPV vaccine (Donadiki et al., 2014). Donadiki et al. (2014) found that young adults were more likely to get the vaccine if they had access to health information. Thus, public education campaigns targeted at young adults to advocate for the vaccine and address concerns around its benefits and safety would help increase uptake rates. At the same time, Donadiki et al. (2014) recommend that registered nurses in schools and colleges intensify individual education among students as a way of addressing misconceptions and spreading accurate information about the vaccine.

Increasing public education campaigns targeting parents of young adults would also increase vaccine uptake rates since Calderon-Mora et al. (2020) found parental consent to be a crucial predictor of vaccination rates among young adults. Approximately 65 percent of parents in the Calderon-Mora et al. (2020) study expressed that they would vaccinate their female children if they had more information on the benefits of the vaccine and its side effects.

At the same time, reducing the cost of the vaccine or availing it for free for those who lack health insurance would significantly increase uptake rates. Over 80 percent of parents participating in the Calderon-Mora et al. (2020) study indicate that they would vaccinate their children if the HPV vaccine was free. At the same time, 75 percent express that they do not know where to get the vaccine and would vaccinate their children if the same was available at school (Calderon-Mora et al. (2020). Thus, school vaccination campaigns present a viable opportunity for increasing vaccine uptake rates among young adults. At the same time, there is a need for more public campaigns to educate the public on where to access the vaccines.

Part Two: Application of the Theory of Planned Behavior in Selected Article

The selected article is titled, ‘Effectiveness of an educational intervention using theory of planned behavior on healthcare empowerment among married reproductive-age women: A randomized controlled trial.’ The full citation appears in the reference list. The article sought to determine the effectiveness of an education intervention geared at improving healthcare empowerment levels among 488 women Iranian women within the reproductive age. The authors use the constructs of the theory of planned behavior to design the educational intervention. The article defines healthcare empowerment as a health improvement process in which “people gain greater control over their decisions, lifestyles, and activities affecting their health” (p.1).

The theory of planned behavior suggests that intention is a fundamental factor in behavioral change. At the same time, intention is driven by three constructs: one’s attitude towards the behavior, perceived behavioral control, and subjective norms. Perceived behavioral control is the extent to which the individual perceives that they have control over their behavior, while subjective norms have to do with how one perceives the thoughts of others such as friends and relatives, towards their behavior. Participants were divided into the control (245) and intervention group (243) and baseline scores obtained on their measure of behavioral intention, attitudes towards health empowerment, behavioral beliefs, subjective norms, and perceived behavioral control as measured by a 44-item questionnaire.

The intervention group was taken through four one-hour educational sessions weekly over a period of one month. The sessions were based on the constructs of the theory of planned behavior. The first session sought to eliminate subjective obstacles to effective healthcare empowerment and improve participants’ attitudes towards having a positive relation with health experts (attitudes). The second session addressed subjective norms by addressing normative beliefs about pregnancy prevention and subjective norms about healthcare empowerment (subjective norms). The third session focused on increasing behavioral control by educating participants on time management and vaccination in health promotion, and available health improvement services (behavioral control). The final session sought to increase outcome evaluations among participants by educating them on the importance of pap-smear tests and breast cancer screenings. Participants additionally received purposeful social media and text messages throughout the period to complement the instruction received.

The theory of planned behavior was useful in the article in two fundamental ways. First, it provided a means to score participants’ pre and post-intervention health empowerment levels by measuring their attitudes, influence of subjective norms, and perceived behavioral control. Moreover, the three constructs of the theory were used to design a theory-informed educational intervention focused on improving attitudes towards health empowerment, addressing subjective and normative beliefs, and increasing behavioral control.

Of the three constructs of behavioral intention as per the theory of planned behavior, only subjective norms failed to yield a statistically significant difference when pre and post intervention scores were compared. There were no changes in scores in the component of subjective norms following the education intervention. Post-intervention results showed an improvement in the mean behavioral intention for healthcare empowerment score among intervention group participants. However, there were no differences in behavioral intention scores in the control group in the pre and post-intervention assessment. The study also reported an increase in mean scores in the construct of attitudes towards health empowerment following the intervention. An increase in attitude would ultimately lead to increased intention for healthcare empowerment. The perceived behavioral control construct yielded the greatest effect following the education intervention. This indicated an increased power to overcome obstacles to health empowerment such as cost, accessibility issues, cultural issues, and societal norms.