Excercise Health Belief Model

Validation in mexican population

• In Mexico, 42% of men were overweight and
26.8% of men were obese, while 35.5% of
women were overweight and 37.5% of women
were obese.

• Exercise can help prevent, slow down the

progression, or manage these diseases
associated with overweight and obesity
• Health Beliefs Model (HBM) has been shown to explain
changes in people’s health behaviors, including exercise

• Physical activity is “any bodily movement produced by

skeletal muscles that results in energy expenditure… [and]
in daily life can be categorized into occupational, sports,
conditioning, household, or other activities” [24]
• Exercise is “a subset of physical activity that is planned,
structured, and repetitive and has a final or an
intermediate objective, the improvement of physical
fitness”
 Health Belief Model
• In the 50s, in an effort to build a psychosocial
model to explain behaviors related to health and
prevention, the conceptual basis of the Health
Belief Model was formulated in collaboration
with Mayhew Derryberry, creator of the Division
of Behavior Studies in the Department of Public
Health
• Social psychologists: Godfrey Hochbaum, Stephen
Kegeles, Hugh Leventhal and Irwin Rosenstock
• Hochbaum in 1952,
– Prevention program against tuberculosis
– More than 1200 adults
– 3 cities
– Willingness to undergo X-ray examinations.
– Found that willingness to undergo examinations
was the product of individual beliefs of
susceptibility to the disease and personal benefits
of early detection
• Proposed, at first, to give an explanation and
prediction of preventative behaviors and to
know the reasons for people not going to
medical examinations for early detection of
diseases or simply to know their health status,
among others preventive behaviors.
• 1970´s - HBM began to be used in research
and health interventions, and evidence in
favor of the model began to be published
• 1984 - Janz and Becker examined the HBM to
account for its effectiveness in practice by
reviewing 46 studies that included health
behaviors like breast self-exams, vaccinations,
exercise, physical activity, smoking, seat belt
use, among others.
 Factor structure of the health beliefs
model
• The HBM is based on three main assumptions
– 1) the belief that a problem is extremely
important to take it into account
– 2) the perception of vulnerability because of that
problem and
– 3) the perception that the action taken will have,
as result, a greater benefit compared with the
personal cost produced
• HBM is composed of two factors that explain
health behaviors:
– the perception of health threat
– the perception that specific health behavior can
reduce or eradicate the threat
• Perception of a health threat
– 1) general health values, which refer to the
interest and concern for one’s health
– 2) personal beliefs about vulnerability
– 3) beliefs about the severity and risk of the
disorder
• Reduction or disappearance of the perceived
threat by adopting a health behavior
– 1) whether or not the person thinks that such a
measure will be effective
– 2) the belief that the benefits of carrying out the
health behavior outweigh the costs.
 Method
• N = 746 (54.6% female, 44.1% male)
– Juarez (23.1%)
– Zacatecas (22.6%)
– Toluca (22.2%)
– Colima (17.5%)
– Guadalajara (14.5%)
• Mean age = 28.54 (SD = 18.89)
• Marital status
– 57.7% single
– 34.1% married
– 4.4% living common law
– 2.0% widowed
– 1.0% divorced
– 0.8% separated
• Sample size for EFA (MacCallum et al)
– Item communalities (moderate –high)
– Number of factors (few)
– Number of items per factor (several)
• “If results show a relatively small number of factors and
moderate to high communalities, then the investigator
can be confident that obtained factors represent a
close match to population factors, even with moderate
to small sample sizes”
• Instruments
– Sociodemografic scale
– EHBMS (Excercise Health Belief Model Scale)
• 32 items, 5 points Likert type
– Item 1 to 26 (not at all, a little, more or less, quite a bit, and a lot
– Item 27 to 32 (I don’t believe, maybe, but it’s unlikely, I believe it’s likely, I
believe it’s very likely, and I believe, I’m sure of it)
– After EFA
• 5 factors
– General health values (α = .84)
– Beliefs about the vulnerability of not exercising (α = .67)
– Beliefs about the severity of not exercising (α = .90)
– Beliefs that exercising can reduce threats (α = .85)
– Beliefs that the benefits exceed the costs of exercising (α = .75)
• Procedure
– Frist draft, 52 items
• 50 participants, 10 of each city, to evaluate the easiness
of reading, response options and the redaction of the
items
– Aplication to 746 participants…
• EFA
– Generalized least squares (MCG)
– Promax rotation method (MRP)
– Kayser Mayer Olkin measure (KMO) = .92
– Bartlett spericity (p<.01)
– Item inclusion criteria
• Max Factor Loading ≥ .3
• Second FL ≥ .1
– Item exclusion criteria
• Max FL < .3
• Two or more shared fators (FL diference < .1)
• EFA
– Final scale 25 items (FL .31 to .92)
• Items excluded by low FL (4, 10, 19)
• Items excluded by shared FL (5, 18)
• Item exlucuded by diferent factor than expected max
factor loading (20)
• Item excluded by modify α from .53 to .67 (6)
• EFA
– Factor 1 (beliefs that the benefits exceed the costs of
exercising)
• Items 21 to 26
• Explains 31.48% of variance
• FL from .41 to .92
– Factor 2 (beliefs that exercising can reduce threats)
• Items 11 to 17
• Explains 10.52% of variance
• FL from .68 to .87
• EFA
– Factor 3 (beliefs about the vulnerability of not exercising)
• Items 27 to 32
• Explains 5.97% of variance
• FL from .41 to .82
– Factor 4 (beliefs about the severity of not exercising)
• Items 7 to 9 (one excluded for increment chronbach alpha)
• Explains 5.16% of variance
• FL from .45 to .91
– Factor 5 (beliefs that exercising can reduce threats)
• Items 1 to 3
• Explains 4.34% of variance
• FL from .79 to .85
• Internal Reliability (Chronbach alpha)
– “General health values” α = 0.88;
– “Beliefs about the vulnerability of not exercising” α = 0.76
– “beliefs about the severity of not exercising” α = 0.67
– “beliefs that exercising can reduce threats” α = 0.91
– “beliefs that the benefits exceed the costs of exercising” α = 0.82