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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Background
The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions
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“22 We developed the questionnaire based on previous surveys, adapting the items to our population of interest.”
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“Supporting the HBM model [12], proposed determinants including perceived benefits, threats, barriers, and self-efficacy were found to predict exercise behavior for both races, which is consistent with the original theoretical pathways [31, 32].”
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“Studies demonstrate that HBM-based interventions can enhance self-management [33]; yet, their ability to predict health behaviors is limited [35].”
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“Because many existing models of treatment adherence have been criticized for including poorly defined or redundant constructs (Balkrishnan & Jayawant, 2007; Jones et al., 2014; Nguyen et al., 2014), the psychometric approach may be uniquely informative.”
Background
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“46 Evidence suggests that individuals are more likely to adhere to health recommendations when they perceive the information to be credible, 47,48 which aligns with the results of the current study.”
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Method
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Method
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Background
Retracted
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“Specifically, the type of family a person belongs to [38], circle of friends [37], media based campaigns [39], opinion leaders and religious influence [35].”
Background
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Method
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Background
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“Resultado que coincide con lo documentado por Jones et al. (2014), quienes en su meta-análisis encontraron que en aquellos estudios que refirieron éxito de la intervención, éste no estuvo relacionado con los factores de dicho modelo.”
Background
Professional help seeking for suicidal ideation among Chinese and Australian university students
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Influential
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Influential
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Mansell, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.009 · Cited by 11
Adopting healthy behaviors: Toward prevention and cures
Anisman, H., & Kusnecov, A. W. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-91904-3.00019-7 · Cited by 7
Psychometric properties of the Korean version of questionnaires on adherence to physical distancing and health beliefs about COVID-19 in the general population
Hong, Y., An, H., Cho, E., Ahmed, O., Ahn, M. H., Yoo, S., & Chung, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1132169 · Cited by 2
Results of Validating the Proprietary Method of Establishing Personal Levels of Vaccination Adherence
Kaunina, D. V., Vasilieva, T. P., & Русских, С. В. (2023) · ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT · doi:10.35627/2219-5238/2023-31-8-17-28 · Cited by 2
Are COVID-19 and climate change competing crises? New evidence on the finite pool of worry and risk-as-feelings hypotheses
Duan, R., Bombara, C., & Crosswell, L. H. (2024) · Journal of Environmental Studies and Sciences · doi:10.1007/s13412-023-00887-w · Cited by 2
“On the one hand, we turn to the health belief model (HBM; Jones et al. 2014) as a well-established theoretical lens for understanding whether and how specific dimensions of COVID-related health beliefs translate to climate change responses.”
On the indirect link between virus anthropomorphism and health behavior: Evidence from the pandemic
Valtorta, R. R., Orabona, N., & Paladino, M. P. (2024) · Acta Psychologica · doi:10.1016/j.actpsy.2024.104155 · Cited by 2
Attitudes Toward Proactive Topical Corticosteroid Use Among Women With Vulval Lichen Sclerosus
Rees, S., Arnold, S., Kherlopian, A., & Fischer, G. O. (2024) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000791 · Cited by 2
Application of Health Belief Model to Comprehend Adherence to COVID-19-appropriate Behavior among COVID-19 Vaccinees in Himachal Pradesh
Gupta, P., Mahajan, A., Chander, V., & Barwal, V. K. (2023) · Indian Journal of Public Health · doi:10.4103/ijph.ijph_1525_22 · Cited by 2
Maintaining Mental Health Through Information Seeking and Sharing Behavior on Social Media
Patel, A. P., & Sari, P. K. (2024) · doi:10.1109/icoict61617.2024.10698675 · Cited by 2
An Exploration of Prioritizing Risk Factors of Coffee Consumption in Kindergarten Children
Lu, Y., & Sun, D. (2025) · Journal of Human Environment and Health Promotion · doi:10.61186/jhehp.11.1.13 · Cited by 2
Discourse and Misconceptions About Sexually Transmitted Infections in Lesbian Subreddits: A Health Belief Model Analysis
Leong, Y. Y., Ophir, Y., Kountz, K., Walter, D., & Feeley, T. H. (2025) · Health Communication · doi:10.1080/10410236.2025.2464810 · Cited by 2
“…utilized the platform to encourage and promote healthier behaviors among its users (see also Record et al., 2018), showing that the construct, cues to action, which is often excluded from empirical tests of the theory (C. J. Jones et al., 2014), may manifest in important ways in novel contexts.”
Improved control of non-communicable diseases (NCDs) requires an additional advanced concept for public health – a perspective from a middle-income country
Muktabhant, B., Schelp, F. P., Kraiklang, R., Chupanit, P., & Sanchaisuriya, P. (2019) · F1000Research · doi:10.12688/f1000research.18423.1 · Cited by 2
A Patient Driven Approach to Patient Safety Interventions
Joseph, U. K. (2018) · Health Care Current Reviews · doi:10.4172/2375-4273.1000226 · Cited by 1
“Even with knowledge that the strength of behavioral theories is strengthened when all constructs are used, cues to action is a rarely applied construct [34].”
Background
Behavior Change in Community Contexts
Trickett, E. J., & Paterson, S. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.028 · Cited by 2
Efforts to Prevent Tuberculosis Transmission Based on the Health Belief Model Theory in West Lombok
Supinganto, A., Kusrini, I., Setyarini, A., Amaliah, L., Hadi, S. P. I., & Budiana, I. (2020) · STRADA JURNAL ILMIAH KESEHATAN · doi:10.30994/sjik.v9i2.463 · Cited by 2
GAMBARAN SELF EFFICACY PADA PASIEN DIABETES TIPE 2 DI POLIKLINIK PENYAKIT DALAM RSUPN DR. CIPTO MANGUNKUSUMO JAKARTA
Chloranyta, S. (2020) · Jurnal Ilmu Keperawatan Medikal Bedah · doi:10.32584/jikmb.v3i2.604 · Cited by 2
Critical health response in the time of COVID-19: lessons from the past
Patel, R. R., & Graham, T. (2021) · South African Journal of Psychology · doi:10.1177/00812463211015047 · Cited by 2
“Similarly, in a systematic review, Jones et al. (2014) identified studies which used HBM as the theoretical basis for interventional impact and success.”
Background
After COVID-19: Improving the Patient's Outpatient Appointment Experience
Gant-Farley, H. Y., Ross, M. K., & Hudak, R. P. (2021) · Journal of Patient Experience · doi:10.1177/23743735211039320 · Cited by 2
“The health belief model is used to explain and predict health behaviors of individuals.(34,35) Missing a prescheduled primary care appointment is a health behavior that can evolve into identifiable patterns of undesirable patient health behaviors.”
Method
Integration Perceived Risk, Travel Constraints, and Social Influences in Theory of Planned Behavior
Putra, K. E. S., Yasa, N. N. K., Sukawati, T. G. R., & Widagda, I. G. N. J. A. (2023) · International Journal of Social Science and Business · doi:10.23887/ijssb.v7i4.61242 · Cited by 4
“Individual intention, which offers the most precise prediction of specific behaviors, is a key component of the TRA and TPB (Jones et al., 2014; Sulat et al., 2018).”
Background
La santé du sommeil : une approche multi-dimensionnelle au service de la prévention et de la santé globale des populations
Philip, P., Micoulaud‐Franchi, J., Taillard, J., & Coelho, J. (2024) · Bulletin de l Académie Nationale de Médecine · doi:10.1016/j.banm.2023.12.013 · Cited by 2
Validation of Educational Tools for Use in a Human Papillomavirus Intervention Study
Hurst, C. S., Hagensee, M. E., Ahmed, S. A., & Smith, J. S. (2015) · Cancer and Oncology Research · doi:10.13189/cor.2015.030302 · Cited by 2
Investigating the Determinants of College Students Information Security Behavior Using a Validated Multiple Regression ModelsPreprint
Al‐diabat, M. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3336446 · Cited by 2
Reconceptualized Health Belief Model
Maloney, E. K. (2022) · The International Encyclopedia of Health Communication · doi:10.1002/9781119678816.iehc0775 · Cited by 2
Shaping Long-term Care Insurance Intentions among Chinese Older Adults: Role of Information Interventions in Health RisksPreprint
Leng, A., Liu, J., Hao, J., Maitland, E., Nicholas, S., & Wang, J. (2024) · Research Square · doi:10.21203/rs.3.rs-3812000/v1 · Cited by 2
Cost-Effectiveness Evaluations of Behavior Change Interventions
Wang, T., Downes, M., Byrnes, J., & Scuffham, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.026 · Cited by 1
Theory of reasoned action and antismoking social marketing
Rybina, L., & Garkavenko, V. (2020) · The Journal of Economic Research & Business Administration · doi:10.26577/be.2020.v132.i2.10 · Cited by 1
Home contact support in prevention of transmission of tuberculosis in west Lombok based on the theory of the health belief model
Sekolah Tinggi Ilmu Kesehatan Yarsi Mataram, M., & Supinganto, A. (2022) · Gaceta Médica de Caracas · doi:10.47307/gmc.2022.130.s5.3 · Cited by 1
Efficacy of a Health Belief Model-Based Intervention for Anticoagulant Adherence in Patients With Atrial Fibrillation: A Randomized Controlled Trial
Chen, P.-T., HSIEH, M., Shih-Chang, K., & Wang, T.-J. T. (2022) · Research and theory for nursing practice · doi:10.1891/rtnp-2021-0068 · Cited by 1
Effect of perioperative airway management on postoperative outcomes of colorectal cancer patients with sarcopenia
Xie, T., Li, L., Yang, X., Wu, X., Wang, M., Chen, W., Dong, Q., Chen, X., & Jiang, L. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102418 · Cited by 1
Adherence to Periodic Dilated Eye Examinations and Its Determinants Among Nepalese Patients With Diagnosed Diabetes: A Single‐Center Hospital‐Based Analysis Using Health Belief Model
Suwal, B., Shrestha, R. K., Khatri, B., & Upadhyay, M. P. (2024) · BioMed Research International · doi:10.1155/2024/3231341 · Cited by 1
“This model considers beliefs and attitudes as proximal determinants of health behavior, including adherence to medical advice [10].”
Background
A Program for Reinforcing Lifestyle Change Motivation and Lifestyle Behavior to Prevent Dementia in Community-Dwelling Middle-Aged and Older Adults: Applying the Health Belief Model
An, H., Hong, I., Han, D., & Park, H. Y. (2025) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580251324046 · Cited by 2
The relationships among breast cancer-related prevention behavior, attitude, knowledge and fatalism in Chinese women with benign breast tumors
Suo, R., Pan, Q., Wu, Y., Li, F., Wang, R., Ye, F., & Zhong, H. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2486502 · Cited by 1
“…health belief model (HBM), individual cognition and attitude toward a disease significantly impact behavior, and knowledge serves as the foundation for behavioral change, whereas attitude act as a driving force and a mediator between knowledge and behavior (Jones et al., 2014; Lau et al., 2020).”
Understanding international travelers’ intentions to adopt protective behaviors against malaria during staying abroad: insights from a study of Chinese international travelers
Wang, Y. F., Fang, F., Li, C., Wang, J., Lu, G., & Huang, Y. (2025) · Globalization and Health · doi:10.1186/s12992-025-01132-5 · Cited by 3
“The significant impact of severity beliefs aligns with prior studies showing that risk perception drives preventive actions more effectively than knowledge alone [39].”
The Expert Patient and the Self-Management of Disability and Chronic Health Conditions
Meade, M. A., Jacobson, L. A., Pilarski, C. R., & Aikens, J. E. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197525456.013.0009 · Cited by 1
Utilizing the Health Belief Model to understand heat mitigation behaviors in the United States: Results of an online panel survey
Martinez, B., Beck, C., & Ghosh, J. K. (2025) · PLoS ONE · doi:10.1371/journal.pone.0334697 · Cited by 2
“Since then, it has been widely used to understand the factors that impact health behaviors [14–18].”
Enablers and barriers to perform upper extremity exercise among patients with newly created arteriovenous fistula for hemodialysis: a qualitative study
Meng, L., Guo, W., & Ho, P. (2025) · BMC Nephrology · doi:10.1186/s12882-025-04518-0 · Cited by 1
“This model was proven to be effective in various health care fields [26–28], like preparation for delivery and HIV prevention.”
What Shapes Telehealth? The Role of Environment and Technology in Communication Quality
Omidi, F., & Pati, D. (2025) · HERD Health Environments Research & Design Journal · doi:10.1177/19375867251396068 · Cited by 1
“The Health Belief Model supports the ﬁ rst pathway by emphasizing that cognitive constructs — such as perceived susceptibility, severity, bene ﬁ ts, and barriers — shape health behaviors (Jones et al., 2014).”
Are we asking the right questions? A dive into the knowledge, attitudes, and practices literature on behavior change in tick bite prevention
Mader, E. M., Lampman, J., Kendregan, H., Diuk‐Wasser, M. A., Fritz, M. L., Harrington, L. C., & Safi, A. G. (2026) · BMC Public Health · doi:10.1186/s12889-026-26270-2 · Cited by 1
“Since then, the HBM has been applied in diverse health behavior contexts, including disease prevention, health education, and program effectiveness evaluation [25, 38, 40].”
Does informational social media use negatively impact preventive behavior during the COVID-19 pandemic? The moderating roles of citizens’ scientific knowledge and trust in science
Schnittka, O., Bohn, R., Ahrholdt, D. C., & Dragin‐Jensen, C. (2026) · Health Marketing Quarterly · doi:10.1080/07359683.2026.2624300 · Cited by 1
“First, message framing strategies can be tailored to HBM constructs by emphasizing loss-avoidance and collective protection (e.g., highlighting risks of noncompliance for vulnerable groups) while simultaneously reducing perceived barriers through transparent communication about side effects and uncertainties.”
Influential

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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