Janz N K, Becker M H
Health Educ Q. 1984 Spring;11(1):1-47. doi: 10.1177/109019818401100101.
Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.
自1974年上次全面综述以来,健康信念模式(HBM)一直是大量理论和研究关注的焦点。本文对1974年至1984年期间发表的29项与HBM相关的调查进行了批判性综述,列出了1974年之前进行的17项研究的结果,并对总共46项HBM研究(18项前瞻性研究,28项回顾性研究)进行了总结。24项研究考察了预防性健康行为(PHB),19项研究探讨了患病角色行为(SRB),3项研究涉及门诊利用情况。构建了一个“显著性比率”,即将HBM某一维度的阳性、具有统计学显著性的研究结果数量除以报告该维度显著性水平的研究总数。综述结果为HBM提供了大量实证支持,前瞻性研究的结果至少与回顾性研究的结果一样有利。在各种研究设计和行为中,“感知障碍”被证明是HBM各维度中最具影响力的。虽然总体上两者都很重要,但“感知易感性”在理解PHB方面比SRB的贡献更大,而“感知益处”的情况则相反。“感知严重性”产生的总体显著性比率最低;然而,虽然它与PHB的关联较弱,但该维度与SRB密切相关。根据所收集的证据,建议在健康教育规划中考虑HBM各维度。还提供了进一步研究的建议。