Cognitive Models
Health Belief Model (HBM)
Developed in the 1950s.
Focus: Explains why people adopt (or don’t adopt) health behaviors, especially
preventive ones.
Core Constructs:
1. Perceived Susceptibility – belief about personal risk (e.g., “I might get
diabetes”).
2. Perceived Severity – belief about seriousness (e.g., “Diabetes can cause major
health problems”).
3. Perceived Benefits – belief in effectiveness of action (e.g., “Exercising will
reduce my risk”).
4. Perceived Barriers – obstacles to action (e.g., “I don’t have time to exercise”).
5. Cues to Action – triggers (doctor’s advice, symptoms, campaigns).
6. Self-Efficacy – confidence in performing the action.
HBM mainly explains preventive health behaviors like screenings, vaccination, exercise, etc.
Protection Motivation Theory (PMT)
Developed in 1975, later refined.
Focus: Explains how fear appeals and threats motivate people to change behavior.
Core Constructs (two appraisals):
1. Threat Appraisal:
o Perceived Severity
o Perceived Vulnerability (similar to susceptibility)
o Rewards of maladaptive behavior (e.g., pleasure from smoking)
2. Coping Appraisal:
o Response Efficacy (belief the action will work)
o Self-Efficacy (belief in ability to act)
o Response Costs (time, money, effort)
PMT is often used for behaviors where fear appeals are common, e.g., anti-smoking
campaigns, safe driving, HIV/AIDS prevention.
Social Cognitive Theories
1. Theory of Planned Behavior (TPB)
Developed by Ajzen (1991).
Focus: Explains how intention leads to behavior.
Key Constructs:
o Attitude toward behavior (positive/negative evaluation).
o Subjective norms (perceived social pressure).
o Perceived behavioral control (how much control one feels over doing it).
Main Idea: Behavior is best predicted by intention, which is shaped by attitudes, norms,
and control.
Example: If I believe exercising is good (attitude), my friends support it (norms), and I feel
capable of doing it (control), then I will form a strong intention to exercise, which predicts
actual exercise.
2. Health Action Process Approach (HAPA)
Developed by Schwarzer (1992).
Focus: Explains how people initiate and maintain healthy behavior.
Two Phases:
1. Motivational Phase → intention formation (influenced by risk perception,
outcome expectancies, self-efficacy).
2. Volitional Phase → planning, action, and maintenance (action planning, coping
planning, recovery self-efficacy).
Main Idea: Forming an intention isn’t enough; people need planning and coping
strategies to turn intention into sustained action.
Example: I intend to start exercising (motivation), I plan when and where to exercise (action
planning), and I prepare to handle obstacles like bad weather (coping planning).
3. Transtheoretical Model (TTM) / Stages of Change
Developed by Prochaska & DiClemente (1983).
Focus: Behavior change is a process over time through distinct stages.
Stages:
1. Precontemplation (not ready).
2. Contemplation (thinking about change).
3. Preparation (planning to act).
4. Action (currently changing).
5. Maintenance (sustaining change).
o Sometimes it includes Relapse stage.
Main Idea: People don’t change overnight; interventions should match their stage of
readiness.
Example: A smoker might first deny needing change (precontemplation), later admit smoking is
harmful (contemplation), then buy nicotine patches (preparation), start using them (action), and
try to avoid relapsing (maintenance).
Key Differences
TTM (Stages of
Aspect TPB HAPA
Change)
Intention predicts Intention → planning → action Behavior changes as a
Focus
behavior → maintenance staged process
Attitude, norms, control Motivation + coping strategies People move through
Core Idea
shape intention turn intention into action stages of readiness
Time Static (at one point in Dynamic, including planning Dynamic, gradual
Dimension time) and coping progression
Explains readiness and
Strength Explains intention well Explains intention-action gap
relapse
Predicting health
Designing interventions with Tailoring interventions
Application behaviors (exercise,
planning and coping to person’s stage
diet)
In short:
TPB = Why do people intend to act.
HAPA = How people turn intention into action and sustain it.
TTM = Stages people go through in changing behavior.