Health Belief Model and Weight Management in African-American Women

Introduction to the Health Belief Model

The Health Belief Model (HBM) is based on the concept of changing a subject's beliefs in order to motivate change in 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 the subsequent weight gain it produces — can have a severe impact on health, and when patients understand their personal susceptibility to these health consequences, patients become more apt to view losing weight as desirable. When patients see the barriers to health improvement as surmountable and the benefits as significant, they are more likely to take action, especially when they also perceive their own self-efficacy as strong.

African Americans have a 1.4 times greater likelihood of being obese compared with non-Hispanic Caucasians — a factor linked to being 33% more likely to suffer from fatal heart disease and 22% more likely to develop terminal cancer (Martinez et al., 2016). While many economic and environmental factors that contribute to obesity may lie beyond an individual's control, it remains important for individuals to take whatever actions are possible to reduce their risk.

Perceived Benefits and Perceived Barriers

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

Despite perceiving barriers to weight loss as very great, participants in the study also viewed the benefits of weight loss as significant. These included getting off insulin, finding better-fitting clothing, having more energy, reducing the pain of osteoarthritis, and serving as healthy role models to children and grandchildren (Martinez et al., 2016). Overall, however, research on overweight individuals suggests that there is often a much stronger belief in the potential barriers to positive behaviors like diet and exercise than in the benefits of adopting them. This pattern stands in contrast to normal-weight and underweight individuals, who are more inclined to accurately perceive the risks of being overweight and to minimize barriers to self-empowered strategies such as improving diet and physical activity (Saghafi-Asl, Aliasgharzadeh, & Asghari-Jafarabadi, 2021). Such evidence challenges the assumption that all people in contemporary society equally perceive obesity as socially undesirable or as a health risk. Notably, even normal-weight African-American women in one study reported perceiving the risks of obesity as much lower than their non-Hispanic Caucasian counterparts (Saghafi-Asl et al., 2021).

These findings suggest that, beyond perceived benefits and barriers considered in the abstract, other constructs must be taken into account to achieve meaningful progress in weight reduction and health behavior change. These include cultural sensitivity to 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 acknowledgment that African-American women may face unique barriers, and identifying culturally specific perceived barriers may be essential when designing effective weight-loss programs.

For example, the perceived social benefits of weight loss among African-American women were found to be lower than among Caucasian women (Ard et al., 2013). Emphasizing other benefits — such as improved physical health and fitness — may therefore be more effective for this demographic than for others. African-American women also identified concerns about the effect of sweat and exercise on their hair, as well as economic barriers such as insufficient time and resources to eat healthfully and exercise regularly. Additionally, overeating driven by high levels of stress was identified as a significant barrier to weight reduction (Ard et al., 2013).

A second construct that may usefully supplement the HBM is the need for community support beyond the dyadic relationship between a healthcare provider and an individual patient. In one study, weight-loss education delivered within faith-based communities was found to be helpful in sustaining behavior change, as well as in educating participants about the risks of being overweight and realistic strategies for improving eating and exercise habits (Martinez et al., 2016).

Conclusion

Saghafi-Asl, M., Aliasgharzadeh, S., & Asghari-Jafarabadi, M. (2021). Correction: Factors influencing weight management behavior among college students: An application of the Health Belief Model. PLOS ONE, 16(5). https://doi.org/10.1371/journal.pone.0252258