Measuring Constructs of The Health Belief Model

Perceived Severity

Perceived severity is one aspect of the health belief model. Perceived severity refers to an individual’s belief about the seriousness of contracting an illness or disease, or the severity of the consequences of leaving it untreated. When combined with perceived susceptibility, they are labeled as perceived threats. When evaluating the severity of a disease, an individual should consider both medical consequences (death and disability) and social consequences (family life, career, and social relationships) of the disease (LaMorte, 2018).

If a person believes that an illness could have severe consequences to any aspect of their life, according to the health belief model, they will be more likely to change a health behavior to prevent the disease. However, if an individual does not consider the risks of an illness or disease to be severe, then they are unlikely to change any behaviors. It is important for public health and health professionals to educate the public on the severity of diseases that they are at risk for in order to encourage behavior change. Education about the specific risks and consequences of conditions or health behaviors can help individuals consider improving health behaviors.


Cervical cancer is the second most common cause of cancer death and a leading cause of morbidity in women worldwide however, most cases are highly preventable and curable. In the study of encouraging women to get pap smears for cervical cancer, data was collected on the perceived severity of cervical cancer. The mean scores of severity of people who have had pap smear tests was higher than the mean scores of perceived severity for those without the test. 89% of the subjects said that they believed that cervical cancer is untreatable and 81% of subjects included that they believed it leads to death (Abotchie and Shokar, 2009).

The perceived severity is higher in those who have had pap smear tests, demonstrating that those who fear the negative consequences of a disease are more likely to make effort to make behavior changes to prevent it. When creating health promotion programs, the beliefs of severity should be considered because it creates fear in people to get them to participate in the program.

Perceived Susceptibility


Perceived susceptibility, also called perceived vulnerability, refers to one’s perception of the risk or the chances of contracting a health disease or condition (Witte, 1992). There is wide variation in a person’s feelings of personal vulnerability to an illness or disease (LaMorte, 2018). It has been shown that an individual’s decision to take on a healthy behavior is influenced by the following factors: knowledge, attitudes and beliefs about the efficacy of alternative actions, perceived vulnerability, and psychological barriers to action, perceived self-efficacy, and interpersonal factors (Karimy, Azarpira, & Araban, 2017.)


In this study, the most important reasons for lack of testing were susceptibility to infection. In other words, perceived susceptibility was low. So that the mean score for perceived susceptibility to CC was 8.9 from 20 which reflects the perceived susceptibility was low in research units. Looking at the results of this analysis, it can be seen that only 19% of subjects at risk for CC found and the rest were for reasons like being young and not using hormonal methods of contraception was not in danger. In this study, the perceived susceptibility was the important factor predicting whether a woman would have a Pap test performed, which should be considered for testing planned training and consultation. Researchers believe that in order to motivate people to take action on specific health behaviors, one must know the potential influence of the uncomfortable, or how they are affected by it (Zareban, Karimy, Niknami, Haidarnia, and Rakhshani, 2014). Health educators should be followed by the risk of negative consequences and to highlight risks for clients to help educate them to create their perceived susceptibility.

Perceived Benefits

The Health Belief Model relies on two main factors to change a health behavior; the desire to avoid illness and the belief that a behavior can prevent the illness (Ganz et al., 2002; Glanz et al., 2008). The second factor in the model relies on perceived benefits, which is the belief that there are potential positive aspects of a health action including a person’s perception of the effectiveness of changing a behavior to reduce the threat of disease. An individual is likely to change a behavior if the health action is perceived as beneficial (LaMorte, 2018).


The study relied on people’s perceptions of the benefits of the screening program to prevent CC. The benefits that individuals focused on were different, however if the benefits outweighed the barriers, then a person was more likely to participate in the screening (Hayden, 2009). 48% of participants claimed that they tested for the benefit of early detection and on-time uterine problems cited. Others perceived that there was a benefit in getting treatment for cervical cancer, easy testing, getting reassured that one doesn’t have cancer, an updated health status, and the belief that Pap smears can decrease the risk of cervical cancer and prolong life (Johnson et al., 2008).



Perceived Barriers

This refers to a person’s feelings on the obstacles to performing a recommended health action. There is wide variation in a person’s feelings on barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient (LaMorte,2018).


Findings showed women with higher scores on the perceived barriers for CC screening were less likely to have ever had a Pap smear than participants with higher scores. Also, some perceived barriers have been described, including: not knowing about the importance of Pap testing, accessibility, time constraints, forgetting to schedule a Pap test, and embarrassment. Similarly, a study by Fernandez-Esquerand Cardenas-Turanzas, showed that access to health care was a significant barrier to Pap test (Fernández et al., 2009).



This refers to the level of a person’s confidence in his or her ability to successfully perform a behavior. This construct was added to the model most recently in mid-1980. Self-efficacy is a construct in many behavioral theories as it directly relates to whether a person performs the desired behavior (LaMorte, 2018). It is also an individual’s belief in his or her capacity to perform behaviors necessary to produce specific performance attainments (Karimy et al., 2016).


The purpose of the descriptive and relational study was to find out in detail the relationship between cervical cancer knowledge, self-efficacy, and health literacy understanding level among married women between the ages of 18- 65 years old. The sample study was made up of up to 400 married women, 18- 65 years who were introduced to a family health center. The independent variables were sociodemographic characteristics while the dependent variables were the knowledge on cancer, self-efficacy, and an individual’s health literacy level. Among the people who participated in the study, 67% had a pap smear. Their score on knowledge was 13 (min-max=1.21). The knowledge score (p=0.001) increased as age increased. The lowest knowledge level (p=0.009) was found in the secondary school graduates. The self-efficacy level of the participants was moderate (83.18 +/- 7.70). Self-efficacy level increased as educational level increased. 55.2% of the participants had health literacy level of 7-8th graders. Among literates, the health literacy level was lower among the literate, primary school graduates, and advanced-age participants (p = 0.000). With the self-efficacy and health literacy levels, increase of the participants positively impacted their knowledge status. The participant’s cervical cancer and Pap smear screening knowledge levels developed as their self-efficacy levels increased. The literate or primary school graduate participants had the self-efficacy and health literacy levels (Tiraki, Z., & Yılmaz, M. 2017).