Models for Effective Health Communication
With several new public health communication projects about to launch at RDW, this is the perfect time to take a fresh look at the Health Belief Model (HBM). It’s been the go-to framework for understanding health behavior for decades — but how well does it hold up today?
In this post, we’ll review the basics of the HBM and explore some newer models that have emerged in recent years. Our hope is that this survey of theories of change will help you assess your approach to health communication and inspire some fresh thinking for the work ahead.
The Health Belief Model
The Health Belief Model was developed in the 1950s by social psychologists working with the U.S. Public Health Service to answer a pressing question: Why weren’t people taking advantage of free or low-cost preventive health services? The resulting model was part of a federal effort to improve public health outcomes by applying insights from psychology.
At its core, the HBM sought to explain how the personal beliefs of idealized rational decision makers influence health behavior — particularly the decision to take (or not take) preventive action. The model introduced four key concepts:
- Perceived susceptibility: How likely do people think they are to get a disease?
- Perceived severity: How serious do they believe the consequences will be?
- Perceived benefits: Do they believe the recommended action will reduce their risk or severity?
- Perceived barriers: What do they see as the obstacles to taking action?
The HBM laid the groundwork for many of the health education and behavior change strategies still in use today, including our campaigns focusing on type-2 diabetes prevention, Zika virus prevention, and flu vaccination. In each case, the four core elements provided valuable directions for A/B message testing.
Limitations of the model
While the HBM remains one of the most widely used frameworks for understanding health behavior, it has limitations. The model focuses primarily on individual beliefs and assumes that people make rational decisions based purely on a calculation of perceived risks and benefits. As we know, real-world behavior is often further shaped by emotional, social, cultural, and structural cues to action that go beyond individual reasoning.
Several limitations of the HBM should be considered as you plan your next intervention or media campaign:
- Social determinants of health: Factors like income, education, housing, neighborhood safety, food security, and access to care all influence whether someone can act on health recommendations regardless of their intentions or beliefs.
- Cultural and community influences: Health decisions are often guided by collective values, family expectations, religious beliefs, and community norms. These group influences can outweigh individual perceptions, especially in tightly knit or traditional communities.
- Systemic racism and inequity: Experiences of discrimination and marginalization among underserved populations can lead to distrust in healthcare systems. This isn’t due to misinformation necessarily, but to lived experiences that shape beliefs about whether care is safe or beneficial.
- Social support and peer influence: Friends, family, and social networks play a powerful role in shaping health related behaviors. Peer pressure, approval, or disapproval can significantly influence decision-making especially among adolescents and young adults.
- Media, policy, and misinformation: As experienced during the COVID-19 pandemic, public narratives, political messaging, and the spread of misinformation can all affect how people perceive health risks and interventions, often independently of scientific evidence.
- Stress, trauma, and emotional barriers: Chronic stress, unresolved trauma, and decision fatigue can interfere with a person’s ability to follow through on even the most basic health actions, regardless of their understanding or motivation.
Theories of change
To address the limitations of the Health Belief Model, a range of newer frameworks that better account for the social, emotional, environmental, and behavioral complexity of health decision-making were developed. These models, identified by the U.S. National Institutes of Health’s Office of Behavioral and Social Sciences Research (OBSSR), are now widely used in public health communications and behavioral science.
Theory of Planned Behavior (TPB)
Behavior is shaped by a person’s intention to act, which is influenced by three key factors: attitudes (beliefs about the behavior), subjective norms (perceived social pressure), and perceived behavioral control (self-efficacy). This model emphasizes the role of both individual reasoning and social influence.
Social Cognitive Theory (SCT)
Behavior results from the dynamic interaction of personal factors, environmental influences, and the behavior itself. It highlights the importance of social learning (observing others), reinforcement, and environmental supports. SCT is particularly effective in designing peer-led programs and media-based interventions.
Transtheoretical Model (TTM), or Stages of Change
Originating in our home state of Rhode Island, this model views behavior change as a progressive journey, with individuals moving through a series of stages: Precontemplation → Contemplation → Preparation → Action → Maintenance → (sometimes Relapse). It is commonly used in programs related to smoking cessation, addiction recovery, and lifestyle change, as it recognizes that people vary in their readiness to change.
Capability-Opportunity-Motivation Model (COM)
Behavior occurs when three essential conditions are met: capability (individual physical and psychological), opportunity (external social and environmental, e.g. availability of support and resources), and motivation (automatic and reflective). This model is increasingly used in health policy, systems design, and digital health because of its practicality and adaptability.
Social Ecological Model (SEM)
This model considers the multiple levels of influence on behavior, including: Individual → Interpersonal → Organizational → Community → Policy. SEM is ideal for community-level interventions and public health planning because it captures the broader system context.
Nudge Theory / Behavioral Economics
Based on insights from psychology and economics, this model focuses on how small changes in the way choices are framed and presented can significantly influence behavior. It addresses automatic, unconscious decision-making, which the HBM tends to overlook.
Together, these models offer richer, more holistic perspectives on how people make health decisions. They also provide you with a more complete toolkit for designing effective interventions and health behavior communications.
The bottom line
The HBM’s focus on the individual as a rational actor in a vacuum oversimplifies complex human behavior. For deeper insight and contextually informed interventions and messaging, it’s best to integrate elements of the newer more holistic models. Here’s to good health!
