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A Meta-Analysis of the Effectiveness of Health Belief Model Variables in Predicting Behavior
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Abstract
The Health Belief Model (HBM; Rosenstock, 1966) was constructed to explain which beliefs should be targeted in communication campaigns to cause positive health behaviors. The model specifies that if individuals perceive a negative health outcome to be severe, perceive themselves to be susceptible to it, perceive the benefits to behaviors that reduce the likelihood of that outcome to be high, and perceive the barriers to adopting those behaviors to be low, then the behavior is likely for those individuals. A meta-analysis of 18 studies (2,702 subjects) was conducted to determine whether measures of these beliefs could longitudinally predict behavior. Benefits and barriers were consistently the strongest predictors. The length of time between measurement of the HBM beliefs and behavior, prevention versus treatment behaviors, and drug-taking regimens versus other behaviors were identified as moderators of the HBM variables' predictive power. Based on the weakness of two of the predictors, the continued use of the direct effects version of the HBM is not recommended.
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“Research has shown that the HBM constructs are predictive of actual behavior”
From Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder (2024) · cites this paper as Carpenter, 2010
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Correlates of Older Adults’ E-Health Information-Seeking Behaviors
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Protection Motivation Theory and consumers’ food safety behaviour in response to COVID-19
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van der Horst, N., van de Hoef, P. A., van Otterloo, P., Klein, M., Brink, M. S., & BACKX, F. J. G. (2018) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000710 · Cited by 37
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“Additionally, attitude measures were expanded with typically highly-predictive benefit and barrier items (Carpenter, 2010) to fully capture PPE opinions identified during preliminary belief elicitation.”
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A text message a day keeps the pulmonologist away
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“Research also indicates that testing a more complex version of the HBM, then we did, may offer greater predictive power [9].”
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Adherencia terapéutica: factores modificadores y estrategias de mejora
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“Para la indagación de estas barreras y la elección de estrategias de intervención, los farmacéuticos pueden valerse de competencias aprendidas a partir de modelos teóricos de cambios de comportamiento en salud, como son el Modelo de Necesidad percibida y Preocupaciones (52), el Modelo de Creencias en Salud (53), el Mo…”
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“These factors are all critical to consider in designing future risk communications; however, it is likely insufficient to target single identified factors or even single categories within the HBM [26,48].”
BackgroundChanging Behavior Using Integrated Theories
Hagger, M. S., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.015 · Cited by 44
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ResultKeren, F., Siddiquei, A. N., Anwar, M., Asmi, F., & Ye, Q. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.664399 · Cited by 35
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BackgroundInfluentialSun Exposure, Tanning Beds, and Herbs That Cure: An Examination of Skin Cancer on Pinterest
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“Meta-analysis of decades of research using HBM indicates that perceived benefits and perceived barriers are the strongest predictors of behavioral change (Carpenter, 2010).”
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BackgroundPredicting oral health behaviors among Iranian students by using health belief model
Goodarzi, A., Heidarnia, A., Tavafian, S. S., & Eslami, M. (2019) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_10_18 · Cited by 34
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Jiang, L., Liu, S., Li, H., Xie, L., & Jiang, Y. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.15802 · Cited by 43
“Cues to action is the most underdeveloped and rarely measured constructs of the HBM, and many reviewers even failed to provide an overview of its effectiveness due to the lack of studies that included it (Carpenter, 2010; Janz & Becker, 1984).”
BackgroundLiao, Q., Wong, W. S., & Fielding, R. (2013) · Vaccine · doi:10.1016/j.vaccine.2013.07.009 · Cited by 34
Obirikorang, Y., Obirikorang, C., Acheampong, E., Anto, E. O., Gyamfi, D., Segbefia, S. P., Boateng, M. O., Dapilla, D. P., Brenya, P. K., Amankwaa, B., et al. (2018) · International Journal of Hypertension · doi:10.1155/2018/4701097 · Cited by 34
“Several retrospective and prospective studies have provided extensive support for the HBM in evaluating a range of health-related behaviours, although some other studies do not fully support this theory [11, 28, 29].”
ResultRomli, R., Shahabudin, S., Saddki, N., & Mokhtar, N. (2020) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2020.21.3.853 · Cited by 54
“This is in line with the observation that health beliefs and behaviours may change over time, rendering a one-time outcome measurement invalid (Carpenter, 2010).”
BackgroundResultFarmers’ Intentions to Implement Foot and Mouth Disease Control Measures in Ethiopia
Jemberu, W. T., Mourits, M. C. M., & Hogeveen, H. (2015) · PLoS ONE · doi:10.1371/journal.pone.0138363 · Cited by 33
“This is consistent with literature which indicates that among the four HBM variables (constructs), the perceived barrier has been the most powerful in predicting behavior across various study designs and behaviors [17,19,24,25].”
ResultZeng, Y., Yuan, Z., Yin, J., Han, Y., Chu, C., & Fang, Y. (2019) · Vaccine · doi:10.1016/j.vaccine.2019.01.071 · Cited by 33
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“HBM has shown an adequate utility in the prediction of the various spectrum of health behaviors [21, 22, 24].”
BackgroundCollege Males’ Enduring and Novel Health Beliefs about the HPV Vaccine
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“Of the core constructs, benefits and barriers are the strongest predictors of behavior (Carpenter, 2010) and therefore serve as the entry point for this research effort.”
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Tshuma, N., Muloongo, K., Nkwei, E. S., Alaba, O. A., Meera, M. S., Mokgobi, M., & Nyasulu, P. S. (2017) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s112841 · Cited by 33
“27 Urbanization in Johannesburg, South Africa, is a catalyst for the rapid development of informal settlements.”
Darwinian Hedonism and the Epidemic of Unhealthy Behavior
Williams, D. M. (2019) · Cambridge University Press eBooks · doi:10.1017/9781316275047 · Cited by 33
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“According to some researchers, this construct may fade or be volatile [43, 52].”
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Rees, F., Geiger, M., Lilleholt, L., Zettler, I., Betsch, C., BOHM, R. M., & Wilhelm, O. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.04.091 · Cited by 32
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“Positive perception and intention towards health behaviour will result in self-efficacy and intention to promote a health behaviour((36,37)).”
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“Based on previous studies, in preventive behavior, perceived benefits, perceived barriers and self-efficacy play a significant role, and in disease screening behavior, perceived susceptibility has the strongest effect on health behavior [13].”
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“Models like the EPPM offer additional predictor variables to consider including in a multidimensional health promotion model (Carpenter, 2010).”
BackgroundAll models are wrong, but some are useful: a comment on Ogden (2016)
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“The Health Belief Model (Carpenter, 2010) is evenmore specific, dealing only with health behaviour.”
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“Carpenter (2010) concluded that perceived benefits were one of the strongest predictors for health behavior while perceived severity was a weak predictor, although the anticipated effect was detected.”
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“The design of the questions for the interview guides was informed by three constructs: (i) the health belief model [34], (ii) the World Health Organization’s five dimensions of adherence to dietary prescriptions [17], and (iii) Sutton’s tool on patients’ perceptions of renal dietary advice [33].”
Tang, L., Liu, W., Thomas, B., Tran, H. T. N., Zou, W., Zhang, X., & Zhi, D. (2021) · JMIR Public Health and Surveillance · doi:10.2196/26720 · Cited by 31
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The threat of appearing lazy, inefficient, and slow? Stereotype threat in the public sector
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“Scholars have argued that reputational threats are central to an understanding of organizations’ behaviour, as they shape the way organizations respond to external pressures and the need for change (Carpenter 2010; Döring et al. 2021; Maor 2015).”
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“This model (HBM; Becker, 1974; Hochbaum, 1958; Rosenstock, 1966), supported by meta-analyses (Carpenter, 2010; DiMatteo et al., 2007; Harrison et al., 1992 2012) found that threat appraisals acted as an important cognitive mechanism to explain how HBM variables (self-efficacy, susceptibility, benefits, barriers, and s…”
InfluentialPersuasive Strategies for Encouraging Social Interaction for Older Adults
Vargheese, J. P., Sripada, S. G., Masthoff, J., & Oren, N. (2016) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2016.1136176 · Cited by 33
Rizer, C., Fagan, M. H., Kilmon, C., & Rath, L. L. (2016) · American Journal of Health Education · doi:10.1080/19325037.2015.1111176 · Cited by 32
“Both susceptibility and severity have been previously shown to have weak relationships to behavior.(24) In a review of HBM research, Janz and Becker(52) suggested that the perceived severity of a health threat may have less predictive value when individuals are unfamiliar with the effects of the health threat and when…”
BackgroundMethodToileting behaviour and related health beliefs among Chinese female nurses
Xu, D., Chen, L., Wan, X., Zhang, Y., Liu, N., & Wang, K. (2016) · International Journal of Clinical Practice · doi:10.1111/ijcp.12798 · Cited by 30
Methodologies for measuring travelers' risk perception of infectious diseases: A systematic review
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“In line with this, a meta-analysis of 18 studies [51] showed that low perceived barriers and high perceived benefits were consistently the strongest predictors of various healthy behaviors such as tuberculosis screening, quitting smoking, taking medication, dental care, condom use, or attending programs.”
Chen, S.-F., Huang, S.-F., Lu, L.-T., Wang, M.-C., Liao, J., & Guo, J. (2016) · BMC Geriatrics · doi:10.1186/s12877-016-0307-1 · Cited by 30
“We found that the four health belief model (HBM) constructs (susceptibility, severity, benefits, and barriers to taking action) coincided with the background of this study and were suitable as a theoretical guideline for developing Q-statements for assessing individual beliefs in preventive fall.”
BackgroundMethodThe Dyadic Experience of Managing Heart Failure
Kim, J. S. R., Risbud, R. D., Gray, C. P., Banerjee, D., & TRIVEDI, R. B. (2019) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000605 · Cited by 32
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Using Ant Colony Optimization for Sensitivity Analysis in Structural Equation Modeling
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“…methods developed for a variety of statistical analyses, such as regression (e.g., Frank, 2000), logistic regression (e.g., Lyles & Lin, 2010), marginal structural models (e.g., Brumback et al., 2004), multiple imputations (e.g., Rezvan et al., 2015), and meta-analysis (e.g., Carpenter, 2010).”
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“Perceived benefits and barriers to behavior change, which were not assessed, are often stronger predictors of behavior than susceptibility and seriousness [36] and may have provided insight into changes in smoking behavior.”
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“…the value of avoiding illness (severity) and the behavioral value of benefits associated with preventative behaviors with their expectancy of being able to avoid illness (susceptibility) and their behavioral expectancy of successfully putting preventative behaviors into practice (Carpenter, 2010).”
BackgroundYang, X., Wei, L., & Liu, Z. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19073887 · Cited by 30
“In particular, a meta-analysis of HBM studies indicated that perceived benefit was the most powerful predictor among all the health belief factors [30].”
BackgroundTemporal Framing in Balanced News Coverage of Artificial Intelligence and Public Attitudes
Choi, S. (2023) · Mass Communication & Society · doi:10.1080/15205436.2023.2248974 · Cited by 38
“Past research suggests that susceptibility and severity are conceptually distinct and that they produce varying effects on behaviors (e.g., Carpenter, 2010; So et al., 2019; Witte, 1996).”
BackgroundPredictors of Participation in Prostate Cancer Screening among Older Men in Jordan
Abuadas, M. H., Petro‐Nustas, W., & Albikawi, Z. F. (2015) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2015.16.13.5377 · Cited by 29
“Furthermore, the current study findings converges with Carpenter (2010) mata-analyses that concludes that perceived barriers and perceived benefits constructs were consistently the strongest predictors of screening behaviors.”
ResultAraban, M., Baharzadeh, K., & Karimy, M. (2017) · European Journal of Public Health · doi:10.1093/eurpub/ckw238 · Cited by 29
Zhong, L., Cao, J., & Xue, F. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1408998 · Cited by 29
“Carpenter (32) provided some of the most compelling evidence for the HBM’s predictive power regarding health-related behaviors through a meta-analysis encompassing 18 studies with 2,702 participants.”
Changing Behavior by Changing Environments
Marteau, T. M., Fletcher, P. C., Hollands, G. J., & Munafo, M. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.014 · Cited by 32
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“Based on HBM, perceived drawbacks were confirmed as the most powerful single predictor of intended expectations [39].”
BackgroundMehanna, A., Elhadi, Y. A. M., & Lucero‐Prisno, D. E. (2021) · Pan African Medical Journal · doi:10.11604/pamj.2021.39.135.29171 · Cited by 28
“Indeed, a considerable amount of research revealed that selfefficacy was a significant predictor of health behavior [21-23] lending support to our findings.”
ResultBaek, J., Kim, K. H., & Choi, J. W. (2022) · BMC Public Health · doi:10.1186/s12889-022-13355-x · Cited by 28
“The HBM model was originally developed to study why patients do not adopt preventive behaviours such as medication and vaccination to minimize their health threat [15].”
MethodHow to promote telemedicine patient adoption behavior for greener healthcare?
Lu, W., Wei, D., Li, C., Gao, P., Ma, R., Zhai, Y., & Wang, C. (2023) · Journal of Cleaner Production · doi:10.1016/j.jclepro.2023.139884 · Cited by 29
A Qualitative Examination of African Americans’ Organ Donation-Related Medical Mistrust Beliefs
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“A recent meta-analysis (k¼ 18) discovered benefits and barriers were consistently the strongest predictors of behaviors (Carpenter, 2010).”
BackgroundThe Association Between Healthy Lifestyle Behaviours and Coronavirus Protective Behaviours
Nudelman, G., Peleg, S., & Shiloh, S. (2021) · International Journal of Behavioral Medicine · doi:10.1007/s12529-021-09960-6 · Cited by 27
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“The HBM was developed to help explain why individuals neglect to participate in health screenings and has since become established as perhaps the most widely used contemporary health behavior theory [16].”
BackgroundWang, X., Wong, Y. D., Kim, T. Y., & Yuen, K. F. (2023) · Electronic Commerce Research and Applications · doi:10.1016/j.elerap.2023.101273 · Cited by 27
Moral reframing of messages about mask-wearing during the COVID-19 pandemic
Kaplan, J., Vaccaro, A. G., Henning, M., & Christov‐Moore, L. (2023) · Scientific Reports · doi:10.1038/s41598-023-37075-3 · Cited by 34
Protecting the Next Generation
Sundstrom, B. L., Carr, L. A., DeMaria, A. L., Korte, J. E., Modesitt, S. C., & Pierce, J. Y. (2015) · Social Marketing Quarterly · doi:10.1177/1524500415598984 · Cited by 27
“A recent meta-analysis revealed that benefits and barriers offer the strongest predictors of behavior change (Carpenter, 2010).”
BackgroundMethodInfluentialThe impact of negative treatment experiences on persistent refusal of antipsychotics
Lincoln, T. M., Jung, E., Wiesjahn, M., Wendt, H., Bock, T. A., & Schlier, B. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.07.009 · Cited by 27
“Taken together, the decision not to take medication might thus not only be due to a lack of “insight”, but could also be the result of a rational decision after weighing up the pros (e.g., relief from distressing acute positive symptoms) with the cons (e.g., distressing side effects, unknown long-term side effects, pa…”
BackgroundZhang, L.-L., Dalal, K., & Wang, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070563 · Cited by 27
“The health belief model has traditionally been used for the explanation and prediction of the individual behaviours [34].”
MethodLi, W., Nowak, G. J., Jin, Y., & Cacciatore, M. A. (2018) · Journal of Health Communication · doi:10.1080/10810730.2018.1493060 · Cited by 26
“The HBM is one of the most used theories in health promotion and communication to explain and predict the adoption of health behaviors (Carpenter, 2010; Glanz & Bishop, 2010).”
BackgroundExperiences related to health promotion behaviors in overweight pregnant women: a qualitative study
Fathnezhad‐Kazemi, A., & Hajian, S. (2018) · Reproductive Health · doi:10.1186/s12978-018-0660-y · Cited by 26
Stephens, A. B., Wynn, C. S., & Stockwell, M. S. (2019) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2019.1611158 · Cited by 27
“tailored to the audience with particular emphasis on appealing to the various areas of the Health Belief Model (susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) which has been applied effectively to interventions aimed to improve health behaviors.(133) For example, the Mohanty study use…”
MethodDesign, Implementation, and Evaluation of Behavior Change Interventions: A Ten-Task Guide
Abraham, C., & Denford, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.019 · Cited by 27
Changing Behavior Using the Reflective-Impulsive Model
Deutsch, R., & Strack, F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.012 · Cited by 30
Pereira, C. G., Rabello, C. B.-V., Barros, M. R., Manso, H. E. C. D. C. C., dos Santos, M. J. B., Faria, A. G., de Oliveira, H. B., Medeiros-Ventura, W. R. L., Júnior, R. V. S., Carvalho, C. C. D., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0239229 · Cited by 26
Huskey, R., Wilcox, S., Clayton, R. B., & Keene, J. R. (2020) · Annals of the International Communication Association · doi:10.1080/23808985.2020.1839939 · Cited by 26
“A meta-analysis might endeavor to falsify one or several sub-components of a theory or model (e.g., Banas & Rains, 2010; Carpenter, 2010; Huang & Shen, 2016), or a study might aim to metaanalytically summarize results within a given research domain (e.”
BackgroundWang, X., Wong, Y. D., & Yuen, K. F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168574 · Cited by 29
Khalafalla, H. E., Tumambeng, M. Z., Halawi, M. H. A., Masmali, E. M. A., Tashari, T. B. M., Arishi, F. H., Shadad, R. H. M., Alfaraj, S. Z. A., Fathi, S. M. A., & Mahfouz, M. S. (2022) · Vaccines · doi:10.3390/vaccines10020289 · Cited by 27
“Other studies showed that the HBM constructs predict behavior with the exception of “perceived severity” [25,26].”
BackgroundMirtskhulava, V., Whitaker, J. A., Kipiani, M., Harris, D. A., Tabagari, N., Owen‐Smith, A. A., Kempker, R. R., & Blumberg, H. M. (2015) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2015.5 · Cited by 26
Kung, P., Yeh, M. C., Lai, M., & Liu, H. (2017) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000181 · Cited by 26
“Interestingly, although many previous studies have found perceived barriers to treatment adherence to be the strongest predictor of compliance (Carpenter, 2010; Wang, CharronProchownik, Sereika, Siminerio, & Kim, 2006), it was not identified as a significant predictor in the current study.”
BackgroundSgaier, S. K., Eletskaya, M., Engl, E., Mugurungi, O. M., Tambatamba, B. C., Ncube, G., Xaba, S., Nanga, A., Gogolina, S., Odawo, P., et al. (2017) · eLife · doi:10.7554/elife.25923 · Cited by 25
Hasan, U. A., Hairon, S. M., Yaacob, N. M., Daud, A., Hamid, A. A., Hassan, N., Ariffin, M. F., & Vun, L. Y. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16132251 · Cited by 26
Breast Cancer Voices on Pinterest: Raising Awareness or Just an Inspirational Image?
Miller, C. A., Guidry, J. P. D., & Fuemmeler, B. F. (2019) · Health Education & Behavior · doi:10.1177/1090198119863774 · Cited by 26
“…behavior theory focused on six constructs to explain a variety of longand short-term health behaviors (Janz & Becker, 1984) that has been widely used to guide health promotion interventions, including cancer prevention and education programs (Carpenter, 2010; Glanz, Rimer, & Viswanath, 2015).”
BackgroundMethodHanauer, M., Walker, M. R., Machledt, K., Ragatz, M., & Macy, J. T. (2019) · Journal of American College Health · doi:10.1080/07448481.2019.1676757 · Cited by 26
“Some researchers have found similar negative relationships between perceived health risks of substance use and reported substance use, while others have found no significant relationship.(29) The lack of a uniform definition of perceived risk of harm and the limited data focusing on the effect of demographic variables…”
BackgroundWhich Healthy Eating Nudges Work Best? A Meta-Analysis of Field ExperimentsPreprint
Cadario, R., & Chandon, P. (2017) · SSRN Electronic Journal · doi:10.2139/ssrn.3090829 · Cited by 27
Lee, B., 김채린, 윤문영, 김민희, 손영곤, & 이상록 (2014) · Journal of Public Relations · doi:10.15814/jpr.2014.18.2.163 · Cited by 37
Adoption of video consultations during the COVID-19 pandemic
Pereira, F. V., Tavares, J., & Oliveira, T. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100602 · Cited by 29
“The HBM states that people are more motivated to act in healthy ways given the belief that they are susceptible to adverse health consequences (Carpenter, 2010).”
Bistricky, S. L., Harper, K. L., Roberts, C. M., Cook, D. M., Schield, S., Bui, J., & Short, M. B. (2017) · American Journal of Health Education · doi:10.1080/19325037.2017.1377651 · Cited by 25
“have demonstrated moderate explanatory and predictive effectiveness.(46,49) However, it is less clear whether adding cues to action or health motivation components augment predictive utility.”
BackgroundBhuiya, T., Klares, R., Conte, M., & Cervia, J. S. (2021) · Journal of Investigative Medicine · doi:10.1136/jim-2021-001835 · Cited by 25
Metadata
- Authors
- Carpenter, C. J.
- Affiliations
- Western Illinois University (US)
- Corresponding author
- Carpenter, Christopher J.
- Venue
- Health Communication
- Publisher
- Informa UK Limited
- Published
- 2010-11-30
- Volume
- 25
- Issue
- 8
- Pages
- 661-669
- ISSN
- 1041-0236 (ISSN-L)
- 1532-7027
- OpenAlex
- W2102635611
- Cited by
- 1,604
- References
- 37
- Citations by year
- 2026: 138 · 2025: 133 · 2024: 118 · 2023: 173 · 2022: 166 · 2021: 190 · 2020: 164 · 2019: 108 · 2018: 75 · 2017: 78 · 2016: 93 · 2015: 53 · 2014: 53 · 2013: 30 · 2012: 24
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Communication (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Communication › Media Influence and Health
- Health Sciences › Health Professions › General Health Professions › Health and Wellbeing Research
- Keywords
- Health Belief Model, health behavior prediction, perceived benefits, perceived barriers, perceived susceptibility, perceived severity, health campaigns, longitudinal prediction
- MeSH terms
- Humans, Health Knowledge, Attitudes, Practice, Models, Psychological, Health Behavior, Health Communication
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