Health Beliefs and Behaviors

Health Belief Model: Weight Management with African-American Women

The health belief model (HBM) is based upon the concept of changing a subject’s beliefs to motivate change in his or her behavior. Critical components of the model include “perceived severity, perceived susceptibility, perceived barriers, perceived benefits, self-efficacy,” and “cues to action” (Martinez et al., 2016, p.3). For example, when healthcare providers convince patients that a behavior such as overeating and subsequent weight gain can have a severe impact upon health and when patients understand their susceptibility to these health consequences, patients are more apt to view losing weight as desirable. When patients view barriers to achieving health improvement as surmountable and the benefits seem great, they are more apt to take action, especially if they view their own self-efficacy and ability to take such actions as significant.

Perceived Benefits and Perceived Barriers

African Americans have a 1.4 times greater likelihood of being obese compared with non-Hispanic Caucasians, a factor linked to being also 33% more likely to suffer from fatal heart disease, and 22% from terminal cancer (Martinez et al., 2016). While there are many economic and environmental factors that may contribute to obesity beyond the subject’s control, it is still important for individuals to take what actions are possible and necessary to reduce their risk.

In one study using the HBM to facilitate self-efficacy to reduce weight and improve the health of African American residents in rural areas, participants identified their family history, age, and cultural factors (such as being taught in childhood to eat everything on their plates because food was scarce) as perceived barriers to improving health (Martinez et al., 2016). They also cited difficulty in altering their sedentary lifestyles after so many years, a lack of time to cook because of their busy schedules, and dependency upon fast food as a source of quick and easy meals that were filling (Martinez et al., 2016). Learning to cook relatively calorie-dense foods had been a critical component of many of the participants’ upbringings.

However, although the participants in the study perceived barriers to weight loss as very great, it is also noteworthy that the benefits of weight loss were likewise seen as significant, including getting off insulin, finding better-fitting clothing, having more energy, reducing the pain of osteoarthritis, and being healthy role models to children and grandchildren (Martinez et al., 2016). Overall, however, studies of overweight persons have suggested that there is often a much higher belief in the potential barriers to positive behaviors like diet and exercise, versus the benefits of doing so. This is when compared with normal and underweight individuals, who are more inclined to understand accurately the risks of being overweight and minimize barriers to self-empowered strategies such as improving diet and exercise (Saghafi-Asl, Aliasgharzadeh, & Asghari-Jafarabadi, 2021). Such evidence challenges some stated assumptions that all people in today’s society equally perceive obesity as socially undesirable and a risk. Even normal weight African American women in one study reported perceiving the risks of obesity as much lower than non-Hispanic Caucasian women (Saghafi-Asl et al., 2021).

Other Constructs

This suggests that besides perceived benefits and perceived barriers in the abstract, other constructs are necessary to take into consideration to achieve greater benefits regarding weight reduction and self-empowerment to change behaviors, including cultural sensitivity to cultural perceptions of body image, dietary preferences, and personal economics. For weight loss and health goals to be achieved on a societal level, there must be an acknowledgement of the fact that African American women may face unique barriers regarding weight loss, and identifying culturally specific perceived barriers may be required to ensure the full impact of the HBM when designing weight loss programs.

For example, the perceived social benefits of weight loss among African American women, according to Ard (et al., 2013) were lower than among Caucasian women. Emphasizing other benefits, such as health and fitness, might be more beneficial than in other demographic groups. African American women also identified concerns about the effect of sweat and exercise upon their hair, as well as economic barriers such as a lack of time to eat healthfully and exercise. African American women also reported overeating because of high levels of stress as a significant barrier to weight reduction (Ard et al., 2013).

A second health construct that may be useful to add to the HBM is the need for community support beyond the relationship of healthcare provider and individual patient. In one study by Martinez (et al., 2016), weight loss education and collective efforts in the context of faith-based communities were found to be helpful in sustaining change, as well as educating participants in the risks of being overweight and some ways to enhance healthy eating and exercise habits in a useful and realistic fashion.

Conclusion

The HBM can be a useful way of identifying perceived barriers to health-related goals such as weight loss. It is important to note that not all patients may view weight loss as equally necessary, particularly considering cultural attitudes that may disproportionately affect certain groups, such as African American women. Adding cultural and community dimensions to the HBM model can enhance self-efficacy and more clearly identify barriers to understanding the full impact of health-related decisions. Health-related decisions, such as dietary choices, do not take place in a cultural vacuum, even when they have an individual impact.