Gillam S J
Department of General Practice, St Mary's Hospital Medical School, London.
Br J Gen Pract. 1991 Dec;41(353):510-3.
The health belief model, explaining health and illness behaviour, is 25 years old. Criticisms of the model have included its abstract nature and its emphasis on the rationality of patients' behaviour. Its lack of predictive power means it provides a useful framework rather than a true model. The health belief model is used here to review the literature that has advanced our understanding of the factors affecting uptake of cervical screening. The influence of age and social class on perceptions of vulnerability, and the costs and benefits of screening are highlighted. The body of work reviewed has helped expose inherent limitations of screening programmes. The main obstacles to the success of cervical screening are organizational, for example, the inaccuracy of address registers. Numerous ways of encouraging uptake are identified. These include appropriately worded invitations and educational material, personalized approaches from members of the primary health care team and flexible surgery hours. The incentives introduced under the 1990 general practitioner contract are likely to help increase uptake.
健康信念模型用于解释健康与疾病行为，至今已有25年历史。对该模型的批评包括其抽象性以及对患者行为合理性的强调。其缺乏预测能力意味着它提供的是一个有用的框架而非真正的模型。本文运用健康信念模型回顾了相关文献，这些文献增进了我们对影响子宫颈癌筛查接受率因素的理解。文中强调了年龄和社会阶层对易感性认知的影响，以及筛查的成本与收益。所回顾的这一系列研究有助于揭示筛查项目固有的局限性。子宫颈癌筛查成功的主要障碍在于组织方面，例如地址登记不准确。文中还确定了多种鼓励接受筛查的方法。这些方法包括措辞恰当的邀请和教育材料、初级卫生保健团队成员采用的个性化方法以及灵活的门诊时间。1990年全科医生合同引入的激励措施可能有助于提高接受率。
