UTILIZATION OF THE HEALTH BELIEF MODEL IN REDUCING CHILDHOOD OBESITY

ALEXIS CHAUDRON, PRIYA MEYER, STEPHANIE MILLER, ANISE WHEELER

OBJECTIVES

• Describe the primary care practice setting and childhood obesity related to the Health Behavior Model (HBM).

• Demonstrate the magnitude of the obesity epidemic and its relevance to nursing.

• Describe the HBM and the critical concepts that best relate to solving childhood obesity.

• Analyze and evaluate the HBM using Fawcett and Parse’s framework.

• Provide rationale for using the HBM to solve our practice problem.

• Propose solutions to reduce the incidence of childhood obesity.

• Present potential problems that might occur during implementation and how to apply HBM to solve such issues, including strengths and weaknesses.

INTRODUCTION: HEALTH BEHAVIOR MODEL AND PRACTICE SETTING• Health Behavior Model (HBM) is a basis of teaching nurses how to help their patients

become ready to change their families’ food and physical activity behaviors.

• Parental understanding of the severity of childhood obesity and knowledge of the risks associated with creating an unhealthy home environment are important.

• A goal of this module is to help nurses identify parents in needs for more teaching about childhood obesity and help predict and change their health behaviors in order for them to help their obese children reduce risks associated with the negative consequences obesity. 

• Designed for nurses in primary care settings (pediatrician offices, family medicine offices, etc.) that have long-standing relationships with the patients and their families. 

• Primary care nurses educate frequently and must utilize theory to be effective, which empowers behavior changes and improves healthy behaviors.

PROBLEM: CHILDHOOD OBESITY EPIDEMIC

• Healthy People 2010 classified overweight /obesity as one of ten leading health indicators in the US and has called for a decreased in the rate of children obesity (NHANES, 2007-2008)

• 31.7% of children ages 2-19 years are either overweight with body mass index (BMI) at or greater than the 85th percentile of the reference population or at risk for being overweight with BMI between the 85th and 94th percentiles (NHANES, 2007-2008). 

• Non-Hispanic white boys ages 2 to 19 years old are less likely to be obese than Hispanic boys and non-Hispanic white girls are less likely to be obese than non-Hispanic black girls (Centers for Disease Control and Prevention [CDC], 2011).

PROBLEM: CHILDHOOD OBESITY EPIDEMIC

• The rate of childhood obesity has doubled among children ages 3 to 5 and adolescents age 12 to 19, and has tripled among school age children aged 6 to 11 since 1970 (Institute of Medicine, 2005).

• One out of seven pre-school aged children is classified as obese (CDC, 2011).

RELEVANCE TO NURSING

• Overweight children are at risk of chronic diseases that once were only seen in the adult population (National Institute of Health, 2010).

• Obesity can increase the risk of cancer, type 2 diabetes, dyslipidemia, stroke, hypertension, sleep apnea, osteoarthritis, and gynecological issues (CDC, 2011).

• The cost of obesity is approximately 10% of all medical costs, which is estimated to be $147 billion annually in 2008 (Finkelstein et al., 2009).

REFLECTION

Take a moment to reflect on the patients and community that you interact with…•Is your community or patient population affected?

•Have you thought about what you can do to have a lasting impact?

•Do you struggle with how to influence and change behaviors?

HEALTH BELIEF MODEL• Developed in the 1950’s and is one of the most widely used conceptual

frameworks for understanding health behavior.

• Purpose is to describe and predict health behaviors while attempting to explain the failure of people to participate in a program to prevent specific outcomes.

• The theory often is used to incite or induce behavioral changes.

HEALTH BELIEF MODEL PRINCIPLES• Perceived Susceptibility or belief that one is at risk of developing a

specific disease condition.

• Perceived Severity or the belief that the disease condition is serious and can have bad consequences.

• Perceived Benefits or the belief that taking action will reduce risks and the seriousness of the consequences.

• Perceived Barriers or the belief of what will be a hindrance to adopt the new behavior as well as the cost and the negative effect of not changing behaviors.

HEALTH BELIEF MODEL PRINCIPLES• Cues to Action or factors that prompt to actions and activate readiness to change.

• Can be personal and multi-factorial (Armstrong et al., 2009).• Can influence the perceived threats and result in the individual taking action

(Armstrong et al., 2009).

• Self-efficacy or the self-confidence in one's ability to actually take action in order to reach a desired outcome. • In 1988, Rosenstock added this concept in order to improve changes in current

unhealthy behaviors such as obesity, smoking, and lack of exercises.(Glanz, et al.2002).

RATIONALE FOR HEALTH BELIEF MODEL• HBM helps clinicians assess parents and children’s perception of

obesity and assist in predicting behavior change of patients’ which, in turn, will influence behavior change in the family.

• HBM will allow parents and children to learn the adverse effects of childhood obesity and the benefits of lifestyle changes in terms of good nutrition and exercise.

• HBM will help providers to offer well-thought cues to parents in children in order for allow them to increase their self-efficacy and become motivated to improve their lifestyles.

• Children learn from people they trust, so the parents and teachers are critical elements in weight management.

• Parents can change their own health behaviors and improve their self-confidence in order to help their children improve their diet and maintain healthy weight.

RATIONALE FOR HEALTH BELIEF MODEL

• An improvement in children's lifestyle will reduce the rate of childhood obesity and will accordingly reverse the risks associated with childhood obesity.

• Having concrete knowledge of the health received and the health benefit of changing their lifestyle will encourage children to follow their parents' footsteps thus change their own health behaviors.

• While there is a genetic component to childhood obesity, energy imbalance from low caloric expenditure and high caloric intake is at the root of childhood obesity. 

• HBM could be used to help parents shape their children’s health behaviors by improving their own food environments and increasing their families level of physical activities.  

REFLECTION

Take a moment to reflect on the health behavior model…

•Have you used this model before to address another health issue?

•Do you think that patient education is pivotal in changing health behaviors?

•What do you think is the best vehicle to deliver the message?

EVALUATION    

• Utilized Fawcett’s framework for theory analysis and evaluation.

• HBM has pertinent significance, as it can be used to make valid changes in patient lifestyles and prevention of certain diseases. 

• According to Poss, “the model is useful in explaining health behaviors, it is generalizable to a variety of settings, it is parsimonious, and because it is a middle-range theory, it can generate hypotheses for testing.” (2001, p.1-15)

HBM: IS IT SIGNIFICANT?    

Questions to assess significance:•Are the metaparadigm concepts and propositions addressed by the theory explicit?

•Are the philosophical claims on which the theory is based explicit?

•Is the conceptual model from which the theory was derived explicit?

•Are the authors of knowledge from adjunctive disciplines acknowledged and are bibliographical citations given?

HBM: IS IT SIGNIFICANT?    

Evaluation:•HBM has pertinent significance, as it can be used to make valid changes in patient lifestyles and prevention of certain diseases. 

•According to Poss, “the model is useful in explaining health behaviors, it is generalizable to a variety of settings, it is parsimonious, and because it is a middle-range theory, it can generate hypotheses for testing.”(Poss, 2001)

•HBM has been used to explore changes in many short-term and long-term health behaviors  (Croyle, 2005). 

•It gives nurses tools to better assess their  the disease's perception  of their patients, their "perceived barriers" perceive benefits in order to better understand and predict their behaviors in regard to their disease and develop a more effective teaching measures plan of care for their needs. Therefore, this theory does provide nurse a good frame of reference for disease prevention and health promotion(Croyle, 2005).

HBM: IS IT CLEAR AND CONSISTENT?   

Questions to assess clarity and consistency:•Are all elements of the work congruent?

•Do the concepts reflect semantic clarity and consistency?

•Are there any redundant concepts?

•Do the propositions reflect structural consistency?

•Is the theory parsimonious?

HBM: IS IT CLEAR AND CONSISTENT?   

Evaluation:•HBM is not consistent in predicting certain behaviors in patients and their actions regarding their health (Poss, 2001). 

•HBM offers a clear and consistent representation of the association of health belief and health behaviors and shows "cues to action" as a motivating factors to the change in health behaviors (Becker,1974).

•There are a great deal of inconsistencies when it comes to measure the concepts of the HBM (CITATION, NEED MORE INFO PERHAPS)

HBM: IS IT ADEQUATE?   

Questions to assess adequacy:•Is it testable?

•Is it empirically adequate?

•Is it pragmatically adequate?

HBM: IS IT ADEQUATE?   

Evaluation:•This model is appropriate for many clinical problems, it can be implemented for any perceived health threat or illness to a patient. 

•HBM is one of the more widely used and recognized conceptual frameworks in health education (Croyle, 2005).  This is very well known model that has been used in disease prevention, health promotion and patient's compliance (Croyle, 2005). 

•According to Roden, “since its inception the HBM has been regarded as a very useful tool for nurses to help clients assess and manage their illness prevention or prevent health problems.  It has been used by nurses in different practice areas.” (Roden, 2004)

•Heavy emphasis on psychological factors that influence health behaviors, but it fails to address other factors that are as important such as economic factors, environmental factors and social factors (Croyle, 2005).   

HBM: IS IT FEASIBLE?   

Questions to assess feasibility:

HBM: IS IT FEASIBLE?   

Evaluation:•The nursing actions that would be required with this model are indeed feasible with the expectations for nursing practice and it is within the nursing scope of practice.

•Nurses are expected to teach and provide education to our patients, whether working as RNs, APNs, or otherwise. 

•By providing the correct information to these patients nurses can continue on with the concepts of the model, so that they are able to determine their threat, severity, benefits, and options for working against an illness.

•These nursing actions most often lead to favorable outcomes.  However, at the end of the day it is the patient’s choice of what they want to do regarding their health.

PROPOSED SOLUTION

• Limit time playing with video games and watching television (CDC, 2011)

• Provide children with water rather than sodas and juices (CDC, 2011)

• Provide ample servings of fruits and vegetables,

• Creation of school exercise programs that involves parents will improve lifestyle of children at risks of obesity especially among minority children (McCullum, C., Hoelscher, D., Ward, J., Barroso, C. &

Kelder, 2003).

• Development of national awareness programs focusing on improving lifestyles of different communities in the US., involving participations of media (sport figures, Holiwood stars etc...) as role models (Letsmove.org).

Potential Problems With Implementation

• Much studies based on the HMB and Childhood obesity show that perceived susceptibility and seriousness to be more significantly related to fear-based communications rather than to the prediction of weight loss and behavior changes among obese children and their families (Becker, 1977) & Baranoski, et al, 2003).

• The HMB does not take in account other factors such as environment, food access, ethnicity, socioeconomic aspects etc… that are strongly associated with childhood obesity (Baranoski, et al, 2003).

• The HBM seems to be more effective in short term issue like smoking cessation, breast self-exam and adherence to hypertensive meds, rather that childhood obesity, which required long terms lifestyle changes (Baranoski, et al, 2003).

Potential Problems With Implementation

• The HBM seems to focus more on individual health behaviors change. This could be problematic for the complexity of childhood obesity managment whih is a multifactorial problems requiring changes on a community-level (Becker et al, 1977).

• Very few researches using the HBM have addressed cues to actions, one of the main construct for the HBM (Baranoski, et al, 2003).

MULTIPLE CHOICE QUESTION

A.B.C.D.

MULTIPLE CHOICE ANSWER

A.B.C.

D.

REFERENCESArmstrong, S.N., Anderson, M., Le, E.T., &Nguyen, L.H. (2009). Application of the health belief model to bariatric surgery. Gastroenterological Nursing, 32(3): 171-178.

Baranoski, T, Cullen, K.W., Nicklas, T. , Thompson, D., & Baranoski, J. (2003). Are current health behavior change models helpful in guiding prevention of weight gain efforts? Obesity Research, 11, 23S-43S.

Becker, M.H., Maiman, L.A., Kirscht, J.P., Haefner, D.O., & Drachman, R.H. (1977). The Health Belief Model and prediction of dietary compliance: A Field experiment. Journal of Health and Social Behavior, 18, 348-366.

Centers for Disease Control and Prevention. (2011). Overweight and obesity: Data and facts. Retrieved from http://www.cdc.gov/obesity/childhood/data.html.

Centers for Disease Control and Prevention. (2011). Overweight and obesity: Strategies and solutions. Retrieved from http://www.cdc.gov/obesity/childhood/solutions.html

Centers for Disease Control and Prevention. (March 3, 2011). Overweight and obesity: Health consequences. Retrieved from http://www.cdc.gov/obesity/causes/health.html.

Fawcett, J. (2000). Analysis and evaluation of contemporary nursing knowledge. Nursing Models and Theories. Philadelphia: F. A. Davis.

REFERENCES

Finkelstein, E.A., Trogdon, J.G., Cohen, J.W., & Dietz, W.H. (2009). Annual medical spending attributable to obesity: Payer-and service specific estimates. Health Affairs, 28(5), w808-w817.

National Center for Health, National Heart, Lung and Blood Institute. Disease and Condition Index: Are overweight and obesity?: Bethesda, M.D. National Institute of Health, 2010.

Ogden, C.L., Carroll, M.D., Curtin, L.R., Lamb, M.M. & Flegal, K.M. Prevalence of high body mass index in the US.. Children and adolescents, 2007-2008. JAMA, 303(3), 242-9. 2010. Parse, R. R. (1987). Nursing science: Major paradigms, theories and critiques.  Philadelphia: W. B. Saunders.

Poss, J. (2001). Developing a new model for cross-cultural research: Synthesizing the health belief model and the theory of reasoned action. Advanced Nursing Science, 23(4): 1 – 15.

Roden, J, (2004). Revisiting the health belief model: Nurses applying it to young families and their health promotion needs. Nursing and Health Sciences, 6(1): 1 – 10.