Cited by 421Behavioral Health and InterventionsMedication Adherence and ComplianceMedia Influence and Health

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Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review

Open access

Jones, Christina Jane, Smith, Helen, Llewellyn, Carrie·2014·Health Psychology Review

DOI 10.1080/17437199.2013.802623

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Abstract

Lack of adherence to health-promoting advice challenges the successful prevention and management of many conditions. The Health Belief Model (HBM) was developed in 1966 to predict health-promoting behaviour and has been used in patients with wide variety of disease. The HBM has also been used to inform the development of interventions to improve health behaviours. Several reviews have documented the HBM's performance in predicting behaviour, but no review has addressed its utility in the design of interventions or the efficacy of these interventions. A systematic review was conducted to identify interventional studies which use the HBM as the theoretical basis for intervention design. The HBM has been used continuously in the development of behaviour change interventions for 40 years. Of 18 eligible studies, 14 (78%) reported significant improvements in adherence, with 7 (39%) showing moderate to large effects. However, only six studies used the HBM in its entirety and five different studies measured health beliefs as outcomes. Intervention success appeared to be unrelated to HBM construct addressed challenging the utility of this model as the theoretical basis for adherence-enhancing interventions. Interventions need to be described in full to allow for the identification of effective components and replication of studies.

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Method
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Satyanarayana, V. A., Jackson, C., Siddiqi, K., Chandra, P. S., Huque, R., Dherani, M., Nasreen, S., Murthy, P., & Rahman, A. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-021-00811-5 · Cited by 9
Health perceptions and attitudes on mobile health apps in China
Zhang, X., Raghavan, V. V., & Yang, X. (2023) · Health Informatics Journal · doi:10.1177/14604582231207745 · Cited by 10
“23,24 Although this model is useful in general, prior ﬁ ndings report the model only explains 20% of variances in behavior change.”
The neighbourhood effect on mental well-being in the Global South
Roy, S., & Sowgat, T. (2024) · Cities & Health · doi:10.1080/23748834.2024.2303565 · Cited by 8
“In contrast, subjective measures are the respondents’ perceptions and assessment of neighbourhood features that include assessments of the quantity, quality, and experience of the natural environment (Jones et al .”
An outcome of educational intervention on the menstrual hygiene practices among school girls in Ogun State, Nigeria: a quasi-experimental study
Agbede, C. O., & Ekeanyanwu, U. C. (2021) · Pan African Medical Journal · doi:10.11604/pamj.2021.40.214.30601 · Cited by 9
“However, this has been used in assessing underlying menstrual hygiene-related practices of adolescent girls and also has been used to inform the development of interventions to improve health behaviours [16,17].”
Background
Achieving Comprehensive Prevention of Child Abuse and Neglect
Risser, H. J., Svevo-Cianci, K., Karim, E. J., & Morford, A. E. (2019) · International Journal on Child Maltreatment Research Policy and Practice · doi:10.1007/s42448-019-00024-7 · Cited by 9
Autonomy-Supportive Interventions
Reeve, J., & Cheon, S. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.035 · Cited by 13
Development and validation of dust exposure prevention questionnaire for cardiovascular patients based on the health belief model
Noroozi, F., Eisapareh, K., Bahadori, A., Ghahremani, L., Cousins, R., & Mokarami, H. (2020) · BMC Public Health · doi:10.1186/s12889-020-09871-3 · Cited by 10
General population perceptions of risk in the Covid-19 pandemic: A Romanian case study
Popescu, L., & Vîlcea, C. (2021) · Moravian Geographical Reports · doi:10.2478/mgr-2021-0010 · Cited by 9
“…developed using the Health Belief Model (HBM), which has been used continuously in the development of behaviour change interventions for 40 years (Jones et al., 2014), and which is one of the most popular frameworks for explaining various health behaviours (Sulat et al., 2018), including…”
Method
The Relationship between Information Dissemination Channels, Health Belief, and COVID-19 Vaccination Intention: Evidence from China
Huang, C., Yan, D., & Liang, S. (2023) · Journal of Environmental and Public Health · doi:10.1155/2023/6915125 · Cited by 9
Implementation Science and Translation in Behavior Change
Łuszczyńska, A., Łobczowska, K., & Horodyska, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.023 · Cited by 10
Towards a Holistic Approach to Designing Theory-based Mobile Health InterventionsPreprint
Wang, Y., Fadhil, A., Lange, J.-P., & Reiterer, H. (2017) · arXiv (Cornell University) · doi:10.48550/arxiv.1712.02548 · Cited by 11
“The most recent systematic review of the HBM-related interventions in improving adherences suggests that evidence for endorsing the model for use in adherence-enhancing interventions is weak because no consistent relationship between HBM construct addressed and intervention success is found [36].”
Background
Wearable Devices in Elderly Chronic Disease Management: A Qualitative Study of Barriers and Facilitators
Zhang, H., Xu, J., Lu, X., & Xu, M. (2025) · Journal of Nursing Management · doi:10.1155/jonm/1278057 · Cited by 10
“HBM suggests that individuals’ health behaviors are infu-enced by their perceptions of vulnerability to illness, the seriousness of health risks, and the perceived benefts of taking action, such as using wearable devices [26].”
Farmers’ Intention to Adopt Agronomic Biofortification: The Case of Iodine Biofortified Vegetables in Uganda
Aparo, N. O., Olum, S., Atimango, A. O., Odongo, W., Aloka, B., Ongeng, D., Gellynck, X., & Steur, H. D. (2023) · Horticulturae · doi:10.3390/horticulturae9030401 · Cited by 8
Exploring the determinants of health‐promoting behaviors among miners: A text mining and meta‐analysis
Wang, L., Guo, Y., Yin, X., Wang, Y., & Tong, R. (2023) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12465 · Cited by 8
Prevalence and factors associated with hepatitis b vaccination uptake and completion among communities targeted for mass vaccination in gulu: a cross-sectional study
Kimera, A., Atuyambe, L. M., Mutyaba, H., Nantongo, C., Namagembe, A., Nalumansi, A. M., Basenero, A., Auma, P., Mukiza, N., & Nankya-Mutyoba, J. (2024) · BMC Public Health · doi:10.1186/s12889-024-18330-2 · Cited by 8
“A Key Informant guide was designed guided by the Health Belief model theoretical framework for explaining and predicting health behavior [15].”
Method
The Effects of Education Based on the Health Belief Model on Adherence to Standard Precautions among Operating Room Staff
Osta, A., Vasli, P., Hosseini, M., Nasiri, M., & Rohani, C. (2018) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.60112 · Cited by 8
“The effect of the HBM in predicting and implementing health behaviors has been confirmed (19, 35), and in this study, adherence to SPs was investigated as the desired behavior.”
Background
Consumer Engagement with Prescription Medicine Decisions: Influences of Health Beliefs and Health Communication Sources
Ju, I., Park, T., & Ohs, J. E. (2018) · Health Communication · doi:10.1080/10410236.2018.1545336 · Cited by 8
The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring
Haynes, S. C., Tancredi, D. J., Tong, K. L., Hoch, J. S., Ong, M. K., Ganiats, T. G., Evangelista, L. S., Black, J. T., Auerbach, A. D., & Romano, P. S. (2020) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000689 · Cited by 8
“” A rehospitalization or ED visit may serve as a cue to action by changing the way that the individual perceives both the severity of heart failure and his or her susceptibility to heart failure exacerbations.(23,28) Although cues to action have been less frequently studied than other health belief model variables,(29…”
Background
Family Empowerment Model Based on Belief and Health-Related Quality of Life among Housewives With HIV/AIDS
Nursalam, N., Efendi, F., Tristiana, R. D., Misutarno, M., & Priyantini, D. (2020) · Systematic Reviews in Pharmacy · doi:10.31838/srp.2020.5.37 · Cited by 8
Self-Control Interventions
de Ridder, D. T. D., Gillebaart, M., & Friese, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.040 · Cited by 9
Goal Setting Interventions
Epton, T., & Armitage, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.038 · Cited by 8
Risk perception and conspiracy theory endorsement predict compliance with COVID ‐19 public health measures
Lin, T., Heemskerk, A., Harris, E., & Ebner, N. C. (2022) · British Journal of Psychology · doi:10.1111/bjop.12613 · Cited by 9
Beliefs and Narratives Associated with the Treatment of Chronic Pelvic Pain in Women
Meriwether, K. V., Griego, J., Jansen, S. M., Abudushalamu, F., Petersen, T. R., Dunivan, G. C., Komesu, Y. M., & Page‐Reeves, J. (2022) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2022.12.002 · Cited by 8
A Scoping Review and Field Guide of Theoretical Approaches and Recommendations to Studying the Decision to Adopt Hearing Aids
Iankilevitch, M., Singh, G., & Russo, F. (2022) · Ear and Hearing · doi:10.1097/aud.0000000000001311 · Cited by 9
Sorting Through the Spheres of Influence: Using Modified Pile Sorting to Describe Who Influences Dairy Farmers’ Decision-Making About Safety
Bendixsen, C. G., Barnes, K. L., Kieke, B. A., Schenk, D., Simich, J., & Keifer, M. (2017) · Journal of Agromedicine · doi:10.1080/1059924x.2017.1353938 · Cited by 8
Health beliefs mediates the association between the number of non-communicable diseases and preventive behaviors in middle-aged and older adults in southern China
Huang, Y., Wang, T., Wang, H., Zeng, Y., & Xie, L. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-025-02939-3 · Cited by 7
“Health beliefs, conceptually defined as individuals’ perceptions regarding their vulnerability to illness and the benefits versus barriers of taking preventive actions, are a corner-stone of the Health Belief Model (HBM) [27].”
Structural equation modeling analysis of health belief model-based determinants of COVID-19 preventive behavior of academic staff: a cross-sectional study
Zewdie, A., Nigusie, A., & Wolde, M. (2024) · BMC Infectious Diseases · doi:10.1186/s12879-024-09697-z · Cited by 7
“This finding is similar to meta-analyses of studies that used the HBM, those studies showed that perceived severity was least often significantly associated with intention and behavior [59].”
Result
Development and evaluation of a multimedia intervention to promote cervical cancer prevention among South Asian women in Hong Kong
So, W. K. W., Law, B. M. H., Chan, C. W. H., Leung, D. Y. P., Chan, H. Y. L., & Chair, S. Y. (2019) · Ethnicity and Health · doi:10.1080/13557858.2019.1687657 · Cited by 7
Evaluation of Behavior Change Interventions
Matthews, L., & Simpson, S. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.022 · Cited by 8
Effects of Mindfulness-Based Intervention to Improve Bracing Compliance in Adolescent Idiopathic Scoliosis Patients: a Randomized Controlled Trial
Li, X., Lau, E. N. S., Chan, S. K. C., Lam, T. P., Cheng, J. C. Y., Lee, E. K. P., Wong, S. Y. S., & Yip, B. H. K. (2023) · Mindfulness · doi:10.1007/s12671-022-02021-3 · Cited by 7
How short is too short? A randomised controlled trial evaluating short-term existential behavioural therapy for informal caregivers of palliative patients
Kühnel, M., Marchioro, L., Deffner, V., Bausewein, C., Seidl, H., Siebert, S., & Fegg, M. J. (2020) · Palliative Medicine · doi:10.1177/0269216320911595 · Cited by 7
Motivational Interviewing Interventions
Berman, A. H., Beckman, M., & Lindqvist, H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.045 · Cited by 12
Applying the health belief model to examine college students’ early stage adoption of non-pharmaceutical interventions in response to COVID-19
Hatteberg, S. J., & Kollath‐Cattano, C. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2047698 · Cited by 7
“Such variation in the effectiveness of HBM constructs across behaviors, which has been found in other studies, 33 including those on Table 1. adjusted logistic regression and ordinary least squares regression models for health belief model correlates of students’ nPi adoption.”
Result
Interest in Learning About Fertility Status Among Male Adolescent and Young Adult Survivors of Childhood Cancer
Ferrante, A. C., Gerhardt, C. A., Yeager, N. D., Rausch, J. R., Lehmann, V., O’Brien, S. H., Quinn, G. P., & Nahata, L. (2018) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2018.0094 · Cited by 7
“30,31 However, the HBM has not been applied to examine interest in fertility testing after treatment completion.”
Protecting great apes from disease: Compliance with measures to reduce anthroponotic disease transmission
Nuño, A., Chesney, C., Wellbelove, M., Bersacola, E., Kalema‐Zikusoka, G., Leendertz, F. H., Webber, A. D., & Hockings, K. J. (2022) · People and Nature · doi:10.1002/pan3.10396 · Cited by 6
A cardiovascularis rizikóbecslés és az egészségmagatartás kapcsolata pszichoszociális tényezők tükrében.
Ocsovszky, Z., Martos, T., Otohal, J., Berényi, B., Merkely, B. P., Csabai, M., & Bagyura, Z. (2023) · Orvosi Hetilap · doi:10.1556/650.2023.32685 · Cited by 6
Optimizing Postpartum Care in Rural Communities: Insights from Women in Arizona and Implications for Policy
Okechukwu, A., Magrath, P. A., Alaofè, H., Farland, L. V., Abraham, I. L., Marrero, D. G., Celaya, M. F., & Ehiri, J. E. (2024) · Maternal and Child Health Journal · doi:10.1007/s10995-023-03889-w · Cited by 6
“Since postpartum needs vary between groups, capturing and validating narratives is necessary to guide policy interventions (Jones et al., 2014; Meriwether et al., 2023).”
Background
Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study
Zhang, D. “., Jin, L., Liang, D., Geng, R., Liu, Y., Ling, Y., Jiang, F., & Zhang, Y. (2020) · JMIR Formative Research · doi:10.2196/17179 · Cited by 7
“More participants lived in urban regions than in rural regions (56% [14/25] vs 44% [11/25]).”
Economic and Behavioral Economic Approaches to Behavior Change
Brown, P. M., Cameron, L. D., Wilkinson, M., & Taylor, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.042 · Cited by 7
Mothers' Decision Making Concerning Safe Sleep for Preterm Infants
Capper, B., Damato, E. G., Gutin-Barsman, S., & Dowling, D. (2021) · Advances in Neonatal Care · doi:10.1097/anc.0000000000000952 · Cited by 6
Relationship of spirituality, health engagement, health belief and attitudes toward acceptance and willingness to pay for a COVID-19 vaccine
Handayani, S. L., Rias, Y. A., Kurniasari, M. D., Agustin, R., Rosyad, Y. S., Shih, Y. W., Chang, C.-W., & Tsai, H. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274972 · Cited by 6
“Health belief model (HBM) might predict health promoting behaviors in terms of belief patterns by understanding the interaction between health behaviors and health services utilization [29, 30].”
Background
Evaluating the effectiveness of faith-based breast health education
Brown, M. T., & Cowart, L. W. (2018) · Health Education Journal · doi:10.1177/0017896918778308 · Cited by 6
“According to the health belief model (Jones et al., 2014; Rosenstock, 1974), the likelihood of taking preventive action is influenced by individual perceptions of the risk and seriousness of the disease and requires that the perceived benefits of preventive action be greater than perceived barriers to preventive actio…”
Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence
McCartan, C. J., Yap, J., Firth, J., Stubbs, B., Tully, M. A., Best, P., Webb, P., White, C., Gilbody, S. M., Churchill, R. C., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013557 · Cited by 6
“It can help explain the change and maintenance of health-related behaviours and has been used as a guiding framework for many health-behaviour interventions (Jones 2014).”
BackgroundMethodInfluential

Authors: Jones, C. J., Smith, H., & Llewellyn, C.
Affiliations: Brighton and Sussex Medical School (GB)
Corresponding author: Jones, Christina Jane
ORCID: Jones, Christina Jane
Smith, Helen
Llewellyn, Carrie
Venue: Health Psychology Review
Publisher: Informa UK Limited
Published: 2013-06-12
Volume: 8
Issue: 3
Pages: 253-269
ISSN: 1743-7199 (ISSN-L)
1743-7202
DOI: 10.1080/17437199.2013.802623
OpenAlex: W2069208833
Cited by: 421
References: 57
Citations by year: 2026: 30 · 2025: 42 · 2024: 45 · 2023: 39 · 2022: 48 · 2021: 43 · 2020: 92 · 2019: 21 · 2018: 14 · 2017: 20 · 2016: 12 · 2015: 12 · 2014: 2 · 2013: 1
FWCI: 1.10
Type: journal article
Language: en
Open access: green
figshare.com
Licence: cc-by
Locations: Health Psychology Review (publishedVersion)
PubMed (publishedVersion)
Sussex Research Online (University of Sussex) (submittedVersion)
Figshare (submittedVersion, cc-by)
Topics: Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Social Sciences › Communication › Media Influence and Health
Keywords: Health Belief Model, medication adherence, behaviour change interventions, intervention effectiveness, health beliefs, health behavior
MeSH terms: Humans, Health Knowledge, Attitudes, Practice, Models, Psychological, Patient Compliance, Health Behavior

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Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review

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