HBM or the Health Belief Model was first developed in the 1950s by a social psikologf in the U.S. Public health service that is initiated by a failure on the Prevention and disease prevention programs (Hocbaum 1958, Rosenstok 1960.1974)
Further HBM studied as behavioral symptoms of pain symptoms, especially regarding compliance terdiagnos search process of healing.
Previously, Witson 1925 developed a theory called the Theory of SR stimuli or stimulus which states that everything that happens (behavior) caused due to the reinforcement (reinforcement), Kemusian skiner 1938 corroborates that any behavior that allows a person to get the reward will increase or repeat the behavior. (Reasoning and Thinking)
As mentioned above, most human behavior is operant response. For that to establish this type of response or behavior needs to be created there is a certain condition is called operant conditioning. Procedures formation behavior in this according to Skinner's operant conditioning are as follows:
a. Identify the things that are reinforcing or reinforcer in the form of gifts or rewards for behavior that would be formed.
b. Conduct analysis to identify the components that make up a small desired behavior. Then the components are arranged in proper order to go to the formation of the intended behavior.
c. By using in sequence the components as interim goals, identify the reinforcer or reward for each component.
d. Doing formation behavior using a sequence of components that have made it. If the first component has been done then the prize awarded. This will result in component or behavior (action) is likely to be frequent. If this behavior has been formed and then do the component (behavior) the second, given a prize (the first component does not require a gift anymore), so over and over again until the second component is formed. After that followed with the third component, fourth, and further until all the expected behavior is formed. As an illustration, such as desired so that children have a habit of brushing your teeth before bed. To behave like this then the child must:
· Go to the bathroom before bed.
· Take a toothbrush and toothpaste.
· Take water and rinse.
· Implement brush my teeth.
· Keep a toothbrush and toothpaste.
· Going into the bedroom.
If you can identify the gifts (not money) for each component behavior (component above) then it will be able to do that habit formation. The example above is a simplification of procedures through the establishment of operant conditioning behavior. In fact this procedure are many and very varied and more complex than the example above. Skinner's theory is a very big influence, especially in the United States.
The concepts of control behavior, Behavior Therapy and behavior modification are currently developing is rooted in this theory.
Lewin 1951, 1932 and Tolman's cognitive theory adalalah expert, stated that the behavior caused the subjective value or the expectation (Expectation 0 person in achieving results with Theory tersebut.Ini also called expectation value (Value Expectacy) which involves mental processes such as thinking, reasoning, hypothesis and believe that this harapan.teori Reinforcing arise because of expectations about something that affects behavior.
HBM, containing the main concept is to predict why someone does a certain tintadakan to preserve, protect and control the pain condition, with a look at some of the points of view include:
1. Vulnerability (Perceived susceptibility) that person feels the belief / believe in the possibility of pain that occurs in women at risk dirinya.Misalnya someone has an unfaithful spouse, will feel themselves vulnerable to a sexually transmitted disease.
2. Seriousness (Perceived Severity / seriousility) A person that is predicted tinglkat when suffering from the disease severity.
3. Barriers (Perceived Barrier) is haambatan that exist in a person's healthy behaviors, such as in the case of women who berseiko IMS disease, he will seek prevention by early detection through screening pap smear, but the husband does not support, it is an impediment.
4. Advantages (Benefitt) is a person weigh the benefits between the cost incurred by tingklat illness, such as whether effective cost incurred on pap smear examinations are expensive when compared to the seriousness or the risk of illness.
5. Self Eficacy the person's ability to obtain a certain outcome (Bandura, 1997)
6. Cues To Action, which is iosyarat on an action or a person's readiness to act.
Health belief model is based on three essential factors;
1. Intuk individual readiness to change behavior in order to avoid a disease or reduce health risks.
2. Lack of motivation in an environment that makes changing individual behavior.
3. The behavior itself.
These three factors above are influenced by other factors related to individual personality and environment, and experience related to facilities & health workers.
Individual readiness is influenced by factors such as perceptions about susceptibility to disease, potential threats, the motivation to reduce susceptibility to disease, potential threats, and the belief that behavior change will be an advantage.
Factors that influence changes in behavior is the behavior itself is influenced by individual characteristics, individual assessments of changes in the offer, interaction with health workers recommended behavioral changes, and the experience of trying to change behaviors that are similar.
MEASUREMENT CONCEPT HBM
It is important to measure the entire range of factors that may influence behavior, it is to reduce the presence of measurement error (Error Measurable) and of course will further the validity and reliability.
Measurements must be specific to a particular behavior (eg barriers to mammografy may be somewhat different from the barriers Colonoscopy) and must relavan to populations where the measurement would be digunakan.Perbedaan cultures and populations to scale the application without such inspections tend to produce errors. This means that each scale measuring any act must be clear and have investigated whether viable or not.
For example in breast cancer cases, to prove whether the symptoms of breast pain a person has to do with breast cancer, common symptoms or only the measuring instrument should be clear that the use of mammografy.
There are several models of behavior to protect the health of the commonly used are:
1. Cause Action Theory (Theory of Reasoned Action) is abbreviated by the TRA.
2. Protection motivation theory (Protection Motivation Theory)
3. Theory and subjective expected benefits (Subjective Expected Utility)
ACTION THEORY reasoned (Theory of Reasoned Action / TRA), THEORY OF BEHAVIOR planned (Theory of Planned Behavior / TPB) MODEL BEHAVIOR AND INTEGRATION (Integrated Behavioural Model / IBM)
TRA and TPB focuses on a person's motivation to behave in particular that is the presence of behavioral intention (Behavioural Intention) is the best early behavior and in turn can make a person behave (Attitude)
TPB is an extension of the TRA is further expanded with IBM.
TRA and TPB focuses on the conception of an attitude (attitude), subjective norms and perceived control (Perceived Control) explains the difference between the behavior of behaviors including health behaviors.
Fisbein, 1967 noted that the TRA developed the relationship between attitude (Attitude), intention (intention) and behavior (Behavior)
Changes in on one of the above factors can cause changes in breast cancer penederita perilaku.misalnya on, he will behave detect early and seek the healing process if he had initial intentions and positive attitudes toward breast cancer, so he would behave himself checked by inspection the right of mammografy (in accordance with the scale of measurement that has been discussed above)
So the most important determinant of behavior is behavioral intention (Behavioural Intention), resulting in an attitude (Attitude) towards the running behavior and subjective norm (Subjective norm) related to the behavior.
In ditambhakan TPB perceived control (Perceived Control) on the behavior of a situation where there will be consideration for a person to behave.
In the absence of confidence to be determined individually on the results or attributes in doing perilaku.Jika person believes that the outcome is positive then the implementation perilakun will have a positive attitude as well.
While the subjective norm is determined by the presence of normative beliefs (Nmormative Belief) ie are important to him Induvidual referent (the person who is considered important) to approve or not the implementation of the behavior. For example a person who believes that the referent thinking should not / do not approve of a behavior then there will be a negative subjective norm or sebaliknya.Namun Not everyone is motivated to meet the expectations of referent and subjective norms diaakan have a relatively normal (if the referent is not easily influenced to think negarif)
Measurement Conception TRA and TPB
This measurement uses a scale score of 5 or 7 points or through a scale between "No Maybe-maybe" or "disagree-agree".
For example: "I quit smoking" is a "My weight will cause the rise", meaning that someone would judge that if he quit smoking will cause gained weight. Then the evaluation of the person against this outcome was measured by asking how to assess the degree to which "My weight increased" good or bad.
There are two measurements are indirect measurements are calculated from behavioral beliefs, normative and kontrol.Sedangkan direct measurement using the scale as above as "good-bad".
This direct measurement is very important because it is more strongly associated with intention (intention), subjective norm, perceived control.
MODEL BEHAVIOR INTEGRATED (Integrated Behavior Model / IBM)
Is intyegrasi of TRA and most importantly TPB.Dalam IBM also is intent to do perilaku.Tanpa one's motivation is not likely to perform a particular behavior.
a. If someone has a strong intention of behavior she requires knowledge and skill to perform the behavior.
Intention is determined by three categories namely:
· Attitudes towards the behavior (attitude toward the behavioral) is the overall nature of the perceived pleasant or not a person to perform the behavior.
· Norma perceived (perceived norm) reflects the perceived social pressure a person to run or not tersebut.Konsepsi behavior involves strong social identity within a particular culture which is an indicator of normative influence.
· Personal Agent (personal agency) described by Bandura (2006) as the influence of a person to survive on its own function and environmental events.
b. The existence of an environment that will limit the influence of a behavior to be implemented (Triandis, 1980)
c. Behaviour should be important (Salient) for the person (Becker, 1974)
d. Experience of running behavior can become a habit, so in this case the intention nmenjadi less important.
So, at IBM that the stronger a person's belief that running a behavior will give positive results and avoid negative outcomes, will be more enjoyable sekapnya towards running behavior.
Application of IBM and the TRA / TPB in various Behaviour and Populations
Often behavioral beliefs, normative, and efficacy of different control will affect the person's intention to perform different behaviors. Eg In the above cases of breast cancer, one believes that it mammografy different things that can hurt a person's behavioral beliefs that using condoms with their partner.
Relevant trust m, endasar can also be very different on the same behavior, for this reason Fishbein has stressed over and over again that one should go directly to the population to identify behavioral beliefs, normative, efficacy and control are important and related to the behavior.
Thus, the interview is important in terms of application of this model, to obtain information about the trust behavior in a population.
Factors that will influence the application of this model is the Demographic, personality, attitude and other individuals, but the effect is not direct, is called the distal variable.
In this application, there is a phase which we will pass are:
1. Clearly determine the behavior in action, target, context and time.
2. Conducting interviews with the population to dig information from them about:
· Positive or negative feelings about running behavior (attitudes or influence on one's experience)
· The nature or positive or negative results from running the behavior (behavioral beliefs)
· Normative referent
· Facilitators or barriers to the situation / environment that makes the behavior of easy or difficult to implement (self efficacy and control beliefs)
3. Using the findings of extracting information to design an adequate survey instruments to measure IBM.Semua questions designed to measure the confidence of important issues related to the specific beliefs that are identified in the excavation informasi.Uji try to ensure sususnan questions and reliable response scale format (realible), valid ( valid), and culturally appropriate (culturally Appropriate)
4. Inform IBM of measurement that describes and explains the intentions of behavioral intention should be used as fikus intervention efforts.
5. Using the findings and analysis of the belief that behavior can be the best targets for persuasive communication in an intervention to strengthen the behavioral intention and result in greater behavior.
