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The Health Belief Model relates psychological theories of decision making (which attempt to explain action in a choice situation) to an individual's decision about alternative health behaviors. Rosenstock 1 has attributed the origins of that tradition of behavior motivation theory underlying the Health Belief Model to Lewinian 2 theory of goal setting in the level-of-aspiration situation (a special case of the latter's general field theory). Lewin and associates hypothesized that behavior depends mainly upon two variables: (1) the value placed by an individual on a particular outcome and (2) the individual's estimate of the likelihood that a given action will result in that outcome. POST-LEWINIAN MODELSSince the seminal work of Lewin and his colleagues, five other predictive and parallel models have been advanced to describe action in situations involving risk taking or decision making under uncertainty: (1 ) Tolman's analysis of performance behavior, (2) Rotter's 5 concept of reinforcement or "social learning," (3) Edwards' 8.7 decision theory model of Subjective Expected Utility (SEU) ( 4 ) Atkinson's 8 view of risk-taking behavior as a theory of achievement motivation, and (5) Feather's @,10 analysis of decision making under uncertainty.This approach to predicting behavior is often termed "valueexpectancy." These models of motivation focus primarily on general attainments and changes of the whole organism in relation to its environment ("molar" behavior) rather than on an isolated reaction

The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.

Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically appropriate steps to reduce the cost, complexity, duration, and amount of behavioral change required by the regimen and increasing the regimen's convenience through "tailoring" and other approaches, (3) obtaining a compliance-oriented history of the patient's prior experiences and present health beliefs and, where necessary, employing strategies to modify those perceptions likely to inhibit compliance, (4) improving levels of patient satisfaction, particularly with the provider-patient relationship, (5) arranging for the continued monitoring of the patient's subsequent compliance to treatment, (6) increasing staff awareness of the magnitude and determinants of the noncompliance phenomenon and attempting to develop an "active influence orientation" in each member of the health care team, (7) using such techniques as patient-provider contracts to involve the patient in therapeutic decisions and in the setting of treatment objectives and creating incentives (through rewards and reinforcements) for achieving these objectives, (8) arranging for as much continuity of provider (and other staff) as possible, (9) establishing methods of supervising the patient, including involvement of the patient's social support network, and (10) involving fully the assistance of all available health care providers, assigning specific roles and responsibilities for activities directed at improving adherence to treatment.

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Critiques of research on the Health Belief Model have been directed at the need for: (1) applying the Model to behavior related to chronic illness; (2) multivariate testing of the major dimensions of the Model; (3) developing reliable scales; and (4) explicating the relationships among the beliefs. In an attempt to respond to these concerns, data are presented from a prospective study of mothers' adherence to a diet regimen prescribed for their obese children. The Model components were found, both singly and in combination, to be correlated with the study's measure of dietary compliance. Multiple regression analysis utilizing five belief indices accounted for a substantial portion of the variance in children's weight change. Questionnaire items employed in creating indices for each Model dimension are presented, together with discussion of the internal consistency of each index. Belief intercorrelations appear to demonstrate that distinct Model dimensions exist.

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